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OYLSTON     MEDICAL    PRIZE    QUESTIONS.— The     Revision     Medical 
Committee,   appointed  by  the   President  and  Fellows  of  Harvard  University, 
consists  of  the  following  Physicians  : 

J.   I?.  S.  JACKSON,  M.  D.  HENRY  J.   BIGELOW,  M.  IX 

D    II    STOKER,  M.  D.  RICHARD  M.   HODGES,  M.  I). 

CHAS.  G.   PUTNAM,  M.  D.  CALVIN  ELLIS,  M.  D. 

MORRII.I.  WYMAN,  M.  D.  SAMUEL  CABOT,  M.  D. 

\t  the  annual  meeting,  held  June  I,  1874,  it  was  voted  that  no  dissertation ,  worth} 
of  a  prize,  had  been  offered  on  either  of  the  subjects  proposed  for  1874. 
The  following  are  the  subjects  proposed  for  1875  : 

1.  Original  Researches  in  Medical  Science. 

2.  So-called   "  Concussion  of  the  Spine." 

The  author  of  a  dissertation,  considered  worthy  of  a  prize,  on  either  of  the  sub- 
jects proposed  for  1875,  will  be  entitled  to  a  premium  of  One  Hundred  and  Eifty 
Dollars. 

Dissertations  on  the  above  subjects  must  be  transmitted,  post-paid,  to  J.  B.  S. 
Jackson,  M.  D.,  Boston,  on,  or  before,  the  first  Wednesday  in  April,  1875. 

The  following  are  the  questions  proposed  for  1876  : 

1.  Civil  Hospital-Construction   (not   of   Lunatic  Asylums);   Location,  Materials, 
Arrangement,  Warming,  Ventilation,  Drainage,  Lighting;  with  Designs. 

The  author  of  a  dissertation  on  this  subject,  considered  worthy  of  a  prize,  will  be 
entitled  to  a  premium  of  Three  Hundred  Dollars. 

2.  Do  women  require  mental  and  bodily  rest  during  Menstruation  ;    and  to  what 
extent  ? 

The  author  of  a  dissertation  on  this  subject,  considered  worthy  of  a  prize,  will  be 
entitled  to  a  premium  of  Two  Hundred  Dollars. 

Dissertations  on  these  subjects  must  be  transmitted  as  above,  on,  or  before,  the 
first  Wednesday  in  April,  1876. 

Each  dissertation  must  be  accompanied  by  a  sealed  packet,  on  which  shall  be 
written  some  device  or  sentence,  and  within  which  shall  be  enclosed  the  author's 
name  and  residence.  The  same  device  or  sentence  is  to  be  written  on  the  disserta- 
tion to  which  the  packet  is  attached. 

The  writer  of  each  dissertation  is  expected  to  transmit  his  communication  to  the 
President  of  the  Committee,  J.  B.  S.  JACKSON,  M.  D.,  in  a  distinct  and  plain  hand- 
writing, and  with  the  pages  bound  in  book  form,  within  the  time  specified. 

Any  clue  by  which  the  authorship  of  a  dissertation  is  made  known  to  the  Com- 
mittee, will  debar  such  dissertation  from  competition. 

Preference  will  be  given  to  dissertations  which  exhibit  original  work. 

All  unsuccessful  dissertations  are  deposited  with  the  Secretary,  from  whom  they 
may  be  obtained,  with  the  sealed  packet  unopened,  if  called  for  within  one  year 
after  they  have  been  received. 

By  an  order  adopted  in  1826,  the  Secretary  was  directed  to  publish  annually  the 
following  votes  : 

1st.  That  the  Board  do  not  consider  themselves  as  approving  the  doctrines  con- 
tained in  any  of  the  dissertations  to  which  premiums  may  be  adjudged. 

2d.  That  in  case  of  publication  of  a  successful  dissertation,  the  author  be  con- 
sidered as  bound  to  print  the  above  vote  in  connection  therewith. 

RICHARD  M.  HODGES,  M.D.,  SEC., 

BOSTON,     MASS. 


THE 

( — - 

QUESTION     OF     REST 


FOR 


WOMEN  DURING  MENSTRUATION 


MARY    PUTNAM    JACOBI,  M.D. 

PROFESSOR   OF   MATERIA   MEDICA   IN  THE   WOMAN'S   MEDICAL  COLLEGE,    NEW  YORK 


THE   BOYLSTON   PRIZE   ESSAY   OF   HARVARD   UNIVERSITY 
FOR   1876. 


ILLUSTRATED 


NEW     YORK 
G.     P.     PUTNAM'S     SONS 

182  FIFTH  AVENUE 
1877. 


BY     G.    P.    PUTNAM'S    SONS. 

'877. 


INTRODUCTORY    NOTE. 


THE  writer  of  the  present  essay  feels  the  necessity  of 
craving  indulgence  for  many  imperfections,  due,  in 
part  at  least,  to  the  necessity  of  completing  it  within  a  given 
time,  whether  or  no  the  necessary  material  had  been  accu- 
mulated. This  difficulty  is  inherent  in  all  competitions  for 
prizes,  awarded  at  a  fixed  date.  It  was  somewhat  increased 
in  the  present  case,  from  the  fact  that  the  work  was  only 
begun  one  year  before  the  date  for  'conferring  the  prize,  in- 
stead of  two  years,  as  intended  by  the  committee. 

The  author  desires  to  express  her  great  obligations  to  Dr. 
Victoria  White,  and  Dr.  Mary  Baldwin,  and  other  ladies 
connected  with  the  N.  Y.  Infirmary,  for  their  great  assistance 
in  preparing  the  tables  of  urea  analyses.  A  large  number  of 
these  analyses  were  made  entirely  by  Dr.  White. 

The  writer  also  seizes  this  opportunity  to  thank  very 
warmly  the  ladies,  many  of  them  perfect  strangers  to  her, 
who  have  exerted  themselves  in  procnring  the  statistics 
upon  which  the  first  part  of  this  essay  is  based. 

no   West  Thirty-Fourth  Street,  NEW  YORK,  April,  1877. 


CONTENTS. 


SECTION    I. 

PAGE 

INTRODUCTORY— HISTORICAL— GENERAL  CONSIDERATIONS    IN 

REGARD  TO  LABOR  I 

SECTION   II. 
STATISTICS •  .       .      26 

SECTION   III. 
THEORY  OF  MENSTRUATION ...      64 

SECTION   IV. 
EXPERIMENTAL.       .       .       .       .       .       .       .    ,  .  %     •       •     TI5 

SECTION  V. 
THEORY  OF  SUPPLEMENTAL  NUTRITION      .       .       .       .       .168 

SECTION   VI. 
APPLICATION .       ....    192 

CONCLUSIONS »       ...    223 


DO  WOMEN  REQUIRE  MENTAL  AND 
BODILY  REST   DURING  MENSTRUATION? 

(BOYLSTON   PRIZE  ESSAY,   1876.) 


SECTION     I. 

INTRODUCTORY.— HISTORICAL.— GENERAL  CONSIDERATIONS 
IN   REGARD   TO  LABOR. 

AN  inquiry  into  the  limits  of  human  nature  is  always  le- 
gitimate, and  often  exceedingly  useful.  When  honestly 
made,  it  tends  to  increase  real  force  while  dissipating  illusions 
concerning  imaginary  powers.  Thus  knowledge  of  the  limits 
of  muscular  strength  stimulates  the  invention  of  machines 
many  times  man  power.  Compressed  by  the  admitted  limits 
of  religious  thought1  religious  speculation  is  forced  into  more 
definite  channels,  and  assumes  tasks  at  once  more  robust  and 
more  profitable  than  those,  only  apparently  more  splendid, 
which  had  hitherto  absorbed  its  energies.  When  arbitrary 
attempts  to  modify  the  social  organism  are  rebutted  by  the  un- 
suspected limits  imposed  by  its  laws,  resources  as  unsuspected 
are  revealed  to  those  who  choose  to  look  for  them.  Such  in- 
deed is  the  audacity  of  the  human  intellect^  that  the  discovery 
of  limits  usually  proves  hopeless  in  only  one  case,  namely, 
when  they  are  perceived  to  apply  to  a  different  race,  class,  or 
sex,  from  that  to  which  the  investigator  himself  belongs.  An 
inquiry  into  the  limits  to  activity  and  attainments  that  may  be 
imposed  by  sex,  is  very  frequently  carried  on  in  the  same  spirit 
1  See  Mansel.  Limits  of  Religious  Thought. 


2  THE   QUESTION   OF    REST   FOR   WOMEN. 

as  that  which  hastens  to  ascribe  to  permanent  differences  in 
race  all  the  peculiarities  of  a  class,  and  this  because  the  sex  that 
is  supposed  to  be  limiting  in  its  nature,  is  nearly  ahvays  differ- 
ent from  that  of  the  person  conducting  the  inquiry.  It  is  true 
that  men  have  inquired  with  great  research  into  the  influence 
exerted  upon  the  general  organization  of  man  by  the  special 
character  and  working  of  his  sexual  organization,  but  it  is  rare 
that  this  influence  has  been  regarded  as  "  limiting  "  in  its 
nature.  Moralists  and  theologians  have  pointed  out.  the  nar- 
row limits  into  which  its  undue  ascendancy  might  reduce  the 
rest  of  the  physical  and  mental  life,  but  their  exhortations  have 
always  assumed  that  such  undue  ascendancy  would  never 
be  attained  except  by  wilful  negligence  or  moral  sin.  Phys- 
iologists and  physicians  again,  while  demonstrating  the  slavery 
that  results  from  abuse  of  the  sexual  functions,  have  hinted 
=  of  no  danger  consequent  upon  their  normal  exercise.  On  the 
contrary  their  stimulating  effects  upon  the  rest  of  the  economy 
have  been  portrayed  .in  brilliant  colors  by  even  sober  pens. 
To  the  reproductive  apparatus  is  generally  ascribed  a  perma- 
nent influence  upon  the  organism  of  whose  maximum  devel- 
opment it  constitutes  the  most  elaborate  expression.  The 
development  and  activity  of  this  apparatus,  by  means  of 
which  the  life  of  the  individual  is  linked  to  that  of  the  race, 
are  said  to  be  correlative  with  the  development  and  activity 
of  the  organs  of  individual  life,  and  not  in  inverse  proportion 
to  them.  It  may  indeed  be  considered  as  quite  a  modern 
eccentricity  to  claim  as  an  element  of  superiority  in  man, 
that,  in  the  intervals  of  the  voluntary  exercise  of  sexual 
functions,  "  he  is  practically  unsexed."  !  Were  the  assertion 
true,  which  it  is  far  from  being,  it  would  prove  a  marked 
inferiority  on  his  part  to  organisms  whose  sexual  characters 
are  permanent,  since  both  in  plants  and  animals,  scxual_ 
orgamsms_rank_higher  than  asexual ;  the  development  of  sex 
marks  a  progress  from  the  primitively  neutral  condition  of 
1  Ely  Vande  Walker,  Popular  Science  Monthly,  July,  1875. 


SEX  AS  A   LIMITATION.  3 

young  animals,  and  privation  of  the  organs  of  sex  is  liable  to 
seriously  deteriorate  some  of  the  robust  organs  of  individual 
life.  All  this  is  generally  recognized  in  regard  to  the  mascu- 
line sex.  But  as  soon  as  there  is  question  of  the  other,  the 
fundamental  conception  of  the  subject  seems  to  be  changed. 
Not  alone  the  accidents  of  sex  or  the  abnormal  exercise  of  its 
functions,  but  the  sex  itself  seems  to  be  regarded  as  a  patho- 
logical fact,  constantly  detracting  from  the  sum  total  of 
health,  and  of  healthful  activities.  "  Woman,  in  the  interest^ 
of  the  race  has  been  endowed  with  a  set  of  organs  peculiar  to 
herself,  whose  complexity,  delicacy,  sympathies  and  force, 
are  among  the  marvels  of  creation,1  (Sex  in  Education,  p.  83). 
C O m_t_y^_ (T.rait4-d£s_  maladies  Hes  femmes,  p.  274).  enumer^ 
ates  the  natural  phenomena  of  menstruation,  copulation,  ges- 
tation, parturitlonT^mong  the  ^:auses_of  the  frequency  of 
uterine  disease^  Dr.  Guerin  (Movement  medical  quoted 
by  Munde  Journal  Obstetrics,  Aug.,  1875),  says,  "  There  isnoj 
pjvysiologiral  ronHil-ion  gn  nearly  resembling  disease  as  that 
whjrhjrrnfhirpq  every  monfh  in  an  arlnlr  woman^  change  so 
profound  that  it  has  been  looked  upon  as  the  expression  of  a 
morbid  condition."  TilL  who  declares  that  diseases  of  men- 
struation have  been  the  engrossing  study  of  his  life,  defines 
this_process_to  be  a  "_sero  sanguinolent  secretion  "  propelled 
b_y_an_j)varian  infltreaee-frem-  all  or  different-parts  of  the  gen- 
erative intestine,  and^pjjiicipally  from  the  womb.  It  is  a 
natural  function  peculiar  to  women.  .  .  .  who_are.  sub.^.. 
|ect  to  tfnistiaturalinjirimty  for  about  seven  out  of  the  thirty 
years  of  jj£mductive_iife.3  Hutchins,  in  a  prize  essay  ac- 

1  It  is  true  the  author  adds,  "  If  properly  nurtured  and  cared  for,  they,  (these 
organs)  are  a  source  of  strength  and  power  to  her,"  and  disclaims  that  any  organ 
or  function  in  plant,  animal,  or  human  kind  can  properly  be  regarded  as  a  disa- 
bility or  source  of  weakness. 

^  *  It  is  menstruation  that  is  generally  considered  the  peculiarity  of  the  sex,  which 
most  seriously  cripples  the  individual  energies  of  woman,  since  it  alone  exerts  its 
influence  upon  all,  and  at  all  times  during  adult  life. 

*On  Diseases  of  Menstruation,  1851,  p.  23. 


4  THE   QUESTION   OF   REST   FOR   WOMEN. 

ceptcd  by  a  State  Medical  Association,  says,  '  "  Woman  has  a 
sumjptal  of  nervous  force  equivalent  to  a  man's,  but  this  is 
distributed  over  a  greater  multiplicity  of  organs  and  directed 
to  Jhc_development  and  support  of  special  reproductive 
energies  in  addition  to  those  of  individual  nutrition.  The 
nervous  force  is  therefore  weakened  in  each  organ,— and 

the    period  _of   resistance    of    each, organ— is— weakened,^- 

it  is  more  scnsiU\^e,_ni^pxeJlaJbj£^_demngejnenti2  In  another 
place  the  author  quotes  an  experiment  of  Rabuteau,  as  a 
proof  that  during  menstruation  the  general  nutrition  of  the 
JDody  is  diminished.!  ~H7rt  calls  menstruation  a  condition 
which,  if  not  precisely  morbid,  is  still  often  upon  the  limits 
of  pathology,  and  under  all  circumstances  determines  a 
greater  predisposition  to  different  diseases."  4  The  author  cal- 
culated that  "  every  four  weeks  the  uterus  becomes  hyperae- 
miatecl  in  such  manner  that  almost  the  entire  organism  is 
involved  in  sympathetic  suffering;  and  this  during  three  to 
five  days  every  month,  or  one  to  two  months  out  of  every 
year."  Thus  even  for  the  non-pregnant  woman,  "  a  great 
portion  of  the  time  during  the  period  of  maturity7  is  passed 
under  the  influence  of  the  genital  sphere."  *  Stprer.  in  his 
essay  on  criminal  abortion,  appends  a  note  to  the  paragraph 
devoted  to  female  physlcians^considcred  as  a  special  class  of 
accomplices  to  this  crime  (p.  98),  in  which  he  remarks  that, 
"granting  that  women  in  exceptional  cases  may  have  all 
the  courage,  tact,  ability,  pecuniary  means,  education,  and 

1  Transactions  New  York  State  Medical  Association,  1875. 

-  The  inference  that  women  are  more  liable  to  contract  diseases  at  the  men- 
strual period' bears  so  directly  upon  the  subject  of  this  essay  that  it  will  be  dis- 
cussed in  full  further  on.  It  is  vigorously  contradicted  by  Herard. 

3  We  shall  have  occasion  to  refer  again  to  this  experiment,  and  to  discuss  it 
in  view  of  others  made  to  control  it. 

4  Die  Gewerbeliche  Thatigkeit  der  Frauen,  1873. 

5  We  shall  see,  however,  that  practically,  Hirt  thinks  that  no  modifications 
of  the  industrial  work  of  women,  based  upon  the  existence  of  menstruation,  are 
either  desirable  or  practicable. 


MORBID   EFFECTS   OF   MENSTRUATION.  5 

patience  necessary  to  fit  persons  for  the  cares  and  responsi- 
bilities  of  professiojiaJMjfe.Jhey  still  are  andjnu&t-ke-subject 
to  the  periodical  /^/?r/;;/'/£_nf_rheir  >;py  ;  wkich-Cor-fche-tim^ 
and  in  every  case,  however  unattended  by  physical  suffering, 
unfits  them  for  any  responsible  effort  oflmlnd,  and  in  many 
cases  of  body  also.  It  is  not  to  women  as  physicians  we 
would  object ;  .  .  .  but  to  their  often  infirmity,  during 
which  neither  life  nor  limb  submitted  to  them  would  be  as 
safe  as  at  other  times.  We  could  hardly  allow  to  a  female 
physician  (?)  convicted  of  criminal  abortion,  the  plea  that  the 
act  was  committed  &\]u:\ng___ih.&~  temporary  insanity  of  .her. 
menstruat ion_j  and  yet  at  such  times  a  woman  is  undoubtedly 
more  prone  than  men  to  commit  any  unusual  or  outrageous 
act."1  In  the  same  sense  Dr.  Tilt,  in  an  address  to  the 
Obstetrical  Society  of  London  for  1874,  congratulated  the 
members  upon  their  almost  unanimous  decision  that  women 
were  not  admissible, — "  for  the  profession  felt  that  the  ver- 
dict really  meant  that  women 2  were  not  qualified  by  nature 
to  make  good  midwifery  practitioners  ;  that  they  were  unfit 
to  bear  the  physical  fatigues  and  mental  anxieties  of  obstet- 
rical practice,  at  menstrual  periods,  during  pregnancy  and 
puerperality ;  and  that  it  was  unfair  to  society  to  encourage 
women  to  suppose  they  could  fit  themselves  to  assume  re- 
sponsibilities in  those  formidable  obstetric  emergencies  which 
too  often  completely  paralyze  even  men  of  experience."  * 
Already,  in  1805,  Roussel4  had  declared  menstruation  to  be 

1  Criminal  Abortion,  p.  101.     Boston.     1868. 

5  i.  e.,  in  the  opinion  of  the  Society. 

3  British  Mecl.  Jour.,  Jan.  16,  1875.  It  is  interesting  to  find  in  the  same 
volume  of  this  journal,  an  editorial  commenting  upon  a  local  epidemic  of  puer- 
peral fever  that  had  been  caused  by  the  ignorance  of  a  midwife,  and  concluding 
with  these  words :  "  Every  day  the  fact  presents  itself  with  increasing  importunity 
and  sometimes  hideous  vividness,  that  midwives  must  be  improved  or  abolished. 
The  latter  plan  is  undesirable  and  impossible,  the  former  is  practicable,  urgently 
demanded,  and,  to  our  shame  be  it  written,  has  been  adopted  in  every  European  country 
but  Great  Britain"  4  Systeme  Morale  et  Physique  de  la  Femme,  p.  100. 


6  THE   QUESTION   OE   REST    FOR    WOMEN. 

a  salutary  crisis  intended  to  relieve  a  pathological  condition, 
induced  by  the  excesses  at  table  common  in  advanced  civil- 
izations ;  and  Auber1  attributed  the  phenomena  to  the 
unnatural  restraint  imposed  by  these  same  civilizations  upon 
the  sexual  instinct  [see  Beimel].  According  to  Hageivisch, 
menstruation  is  an  hereditary  disease,  developed  by  civiliza- 
tion, and  according  to  Moscati,  by  the  upright  position  of 
the  human  female.3  A  modification  of  the  doctrines  of  the 
Roussel  school  has  been  recently  advanced  by  King,  of 
Washington,  who  is  apparently  unacquainted  with  the  argu- 
ments of  his  predecessors.  He  asserts  thar  menstruation, 
far  from  affording  relief  to  pathological  conditions,  itself  con- 
stitutes a  morbid  state  fraught  with  danger,  inasmuch  as  it 
is  proof  of  functional  inactivity  on  the  part  of  the  uterus, 
which  becomes  therefore  liable  to  atrophy  by  sclerosis.3  It 
is  the  function  of  the  uterus  to  bear  the  product  of  concep- 
tion, but,  impregnation  not  taking  place,  involution  occurs 
in  the  membrane  by  fatty  degeneration  just  as  it  does  in  the 
muscular  walls  of  the  womb  after  delivery,  with  this  differ- 
ence, that  it  is  at  the  beginning  instead  of  the  end  of  the 
normal  function,  and  before  the  mucous  membrane  has  at  all 
accomplished  the  office  for  which  it  had  been  so  highly 
developed."  Thus,  as  has  been  said,  a  woman  menstruates, 
only  because  she  does  not  conceive."  To  Dr.  King  this 
remark  is  not  merely  the  statement  of  an  obvious  physio- 
logical sequence,  as  when  it  is  said  that  a  man  sleeps  because 
he  is  not  awake,  or  fasts  because  not  employed  in  digestion. 
Hut  he  infers  that  since  gestation  is  the  proper  function  of 
the  adult  uterus,  in  the  absence  of  gestation,  /.  e.,  in  the 
presence  ofjncnstruation,  the  uterus  is_  threat  ciiedwith  the 
atrophy  incurred  by  all  organs  whose  functions  are  unnat- 

1  Quoted  by  Raciborski,  Traite  de  la  Menstruation,  p.  18. 
s  Quoted  and  combated  by  Burdach— Die  Physiologie    Erste  Band  p   240 
1835. 

3  Am.  Journ.  Obst.     August  and  Nov.     1875. 


MORBID   EFFECTS   OF   MENSTRUATION.  7 

urally  suspended.  "  Nature  will  not  support  the  nutrition 
of  a  useless  organ ;  in  the  physiological  offices  of  the  system 
she  will  allow  no  sinecures  ;  hence  we  always  find  that  organs 
performing  no  useful  purpose  become  prone  to  disease,  de- 
generation, and  decay."  As  a  practical  inference,  Dr.  King 
reromm.^nfk^fh^t  girls  bp  encouraged  to  marry  immediately 
upon  arriving  at  the  age  of  puberty,  so  that  menstruation 
may  be  at  once  interrupted  by  a  pregnancy  which  should  be 
repeated  so  frequently  as  to  entirely  exclude  its  pathological 
substitute  from  th'e  existence  of  the  woman.  .  This  view  of 
merfstruatlon  as  a  pathological  process  grafted  upon  the 
female  economy  by  a  progressively  deteriorating  civilization, 
is  in  striking  contrast  with  the  opinions  that  prevailed 
throughout  antiquity,  the  middle  ages,  and  even,  until 
recently,  in  modern  times.  According  to  these  elder  ideas, 
women  are  naturally  plethoric,  in  order  to  be  able  at  the 
proper  time  to  utilize  their  excess  of  blood  for  the  develop- 
ment of  the  foetus.1  Aristotle,  to  whom  Raciborski  attri- 
butes the  first  enunciation  of  this  theory,  calls  the  men- 
strual blood  the  marble,  the  sperm  the  sculptor,  the  foetus 
the  statue.2  The  Hindoo  Susruta  writing  thirteen  or  four- 
teen hundred  years  before  the  Christian  era,  also  explains 
fecundation  by  the  admixture  of  the  semen  with  the  men- 
strual blood,  in  which  latter  is  contained  the  germ  of  the 

embryo.* ______>^ 

Th^plethoric  theory. of  menstruation  was  based ;  first  upon 
the  general  analogy  of  the  menstrual  flux  with  other  evacua- 
tions; and  second  upon  its  relations  to  pregnancy,  of  which  the 
most  superficial  observation  showed  it  to  be  the  substitute. 
The  sense  of  discomfort  or  even  experience  of  danger  attendant 
on  suppression  of  the  evacuations  of  faeces  or  urine,  offered  a 
basis  of  sensation,  upon  which  was  easily  built  the  theory, 

1  Raciborski,  loc.  cit.,  p.  8. 

*  Quoted  by  Flourens,  Cours  d'Embryologie. 

8  Quoted  by  Kreiger,  Die  Menstruation,  1869. 


8  PLETHORIC   THEORY   OF    MENSTRUATION. 

that  all  spontaneous  evacuations  implied  the  existence  of 
some  morbific  material  whose  retention  was  extremely  perilous 
to  the  economy.  The  menstrual  "  purgation  "  was  included 
in  the  generalization.  "The  opinion,  observes  Kreiger, 
that  the  bodv  was  purified  by  the  flux  from  the  uterus, 
became  permanent,  and  was  asserted  still  more  emphatically 
in  the  Commentaries  on  Hippocrates  in  the  sixteenth 
and  seventeenth  centuries.  So  for  instance,  Bapt.  More- 
tarns,  de  uterin  affectionibus,  p.  221."  "The  uterus  is  the 
sewer  of  all  the  excrements  existing  in  the  body  ;  for  all 
decrements  flow  to  the  uterus."  '  On  the  other  hand,  the 
enormous  amount  of  nutritive  material  required  for  the  devel- 
opment of  the  fcetus  was  supposed  to  be  derived  from  some 
reserve  habitually  not  utilized  for  individual  nutrition ;  this 
reserve  could  be  none  other  than  the  blood  thrown  away 
as  superfluous  during  non-pregnant  states,  but  retained  as  soon 
as  the  embryo  began  to  develop.  If  women  escaped  anni- 
hilation during  pregnancy,  it  could  only  be  in  virtue  of  a 
plethora  existing  in  all  other  conditions.  Hippocrates  gives 
an  ingenious  explanation  of  the  cause  of  this  plethora,  not 
accepting  as  sufficient  the  teleological  statement  of  its  utility. 
"  The  woman,"  he  says,  "  has  a  flesh  more  loose  and  soft  (in 
texture)  than  the  man,  and  which  therefore  absorbs  from  the 
abdomen  (nourishing)  fluids  more  rapidly  and  in  greater 
abundance  than  the  masculine  body.  With  this  laxity,  when 
the  body  is  (stuffed)  full  of  blood,  the  tissues  become  hot  and 
plethoric,  and  if  no  evacuation  is  effected,  a  state  of  suffering 
supervenes.  The  blood  of  the  Avoman  is  warmer,  and  this  is 
why  she  herself  is  warmer  than  the  man.2  If,  however,  the 
plenitude  is  evacuated  (in  due  time)  neither  heat  nor  suffer- 
ing is  produced.  The  body  of  the  man,  on  the  other  hand, 
not  being  soft  (and  relaxed)  is  not  susceptible  of  such  vascu- 
lar plenitude,  and  he  is  not  therefore  liable  to  an  excess  of 
heat  as  a  consequence  of  plethora.  Besides,  as  he  exercises 
1  Kreiger.  Loc.  cit.  p.  5.  2  This  is  also  asserted  by  Longet. 


PLETHORIC   THEORY  OF   MENSTRUATION.  9 

more  than  the  woman,  a  part  of  the  (nutritive)  fluid  is  dissi- 
pated by  fatigue."  1 

Sanctorius  believed  that  a  monthly  plethora  occurred 
in  both  men  and  women,  each  of  whom  increased  period- 
ically in  weight  to  the  amount  of  one  or  two  pounds." 2 

Boerhaave  explains  the  plethora  of  women  in  a  different 
manner.  "  About  the  time,"  he  says,  "  that  the  body  of  a 
female  is  arrived  at  its  full  growth,  it  uses  to  make  a  greater 
quantity  of  blood,  than  what  the  vessels  will  contain,  which 
is  the  reason  why  part  of  it  is  let  out  at  the  end  of  the  arte- 
ries of  the  womb,  which  evacuation  is  called  the  monthly 
courses.  If  the  blood  is  retained  then  follows  a  plethora."  3 
The  correlation  between  the  cessation  of  growth,  and  the 
establishment  of  the  menstrual  flow  that  is  presumed  to 
represent  the  nutritive  material  become  excessive  for  the 
needs  of  the  body,  is  insisted  upon  at  greater  length  by 
Haller.  "  At  the  age  of  thirteen,  at  the  same  time  that  the 
semen  begins  to  form  in  the  male,  the  whole  mass  of  blood 
circulates  with  increased  force.  At  this  time  when  the 
growth  of  the  body  begins  considerably  to  diminish,  and  the 
blood,  rinding  easy  admittance  to  completed  viscera,  is  pre- 
pared in  greater  quantity,  a  plethora  frequently  (?)  follows. 
In  the  male  this  is  frequently  vented  by  the  nose.  In -the 
female  a  more  easy  vent  is  found  downwards.  The  uterine 
vessels  are  enlarged,  of  a  soft  fleecy  fabric,  seated  in  a  loose 
hollow  part,  with  a  great  deal  of  cellular  fabric  interspersed, 
very  yielding  and  succulent.  For  these  causes  the  vessels 
being  more  easily  distensible,  the  blood  finds  a  more  easy 
passage  into  the  cavity  of  the  uterus  than  into  any  other  part. 
— Again,  the  return  of  blood  is  more  slow,  both  because  of  the 
flexures  of  the  arteries  which  become  serpentine,  and  retard 

1  Oeuvres  d'Hippocrate  Traduction  Littre  Traite  des  maladies  des  femmes, 
P.  IS- 

*  Aphorism  LXV.,  17^). 

3  Aphorisms,  1290  and  1291.     Translation  from  Latin.  1728. 


10  THE   QUESTION   OF   REST    FOR   WOMEN. 

the  blood  motion,  and  also  because  it  passes  with  more  diffi- 
culty through  the  veins.  The  blood,  therefore,  first  collects 
in  the  vessels  of  the  uterus,  then  accumulates  in  the  arteries 
of  the  loins,  and  the  aorta  itself,  which,  urging  on  a  new  tor- 
rent of  blood  augments  in  force  so  far  as  to  discharge  the  red 
blood  into  the  serous  vessels.'  The  quantity  of  the  menstrual 
flux  is  promoted  by  everything  that  either  increases  the 
quantity  or  the  momentum  of  the  blood  more  particularly 
to  the  uterus,  such  as  joy,  lust,  rich  diet,  warm  air,  lively 
temperament."  " 

Burdach3  (1835)  remarks  that  "as  menstruation  offers 
local  and  general  phenomena,  so  it  depends  upon  local  and 
general  causes.  The  general  cause  is  evidently,  that  in  the 
female  body  the  formation  of  blood  is  sufficiently  rich  to 
provide  every  four  weeks  for  an  overflow  of  the  same — whose 
evacuation  becomes  a  necessity.  For  after  this  evacuation  is 
there  complete  health  and  regularity  of  all  forces,  and  the 
body  has  the  same  weight  as  before.  The  menstruation  is 
richer  when  the  formation  of  blood  is  abundant,  and  weaker 
when  blood  is  deficient,  from  insufficient  foods,  tedious 
disease,  etc.  We  believe  this  excess  of  blood  depends  upon 
an  excess  of  formative  power  in  the  woman,  and  that  the 
menstruation,  in  its  increase  and  decrease,  stands  in  exact 
proportion  to  the  formative  activity,  and  also  to  its  expend- 
iture. For  where  matter  and  force  are  employed  for  the 
movement  and  nutrition  of  the  muscles,  the  plastic  force  can 
develop  itself  less  in  other  directions ;  when  on  the  contrary 
the  muscular  power  is  less  exercised,  then  developes  easily  a 
('  UPP'SC  ')  formation  of  fluid  material.  The  menstruation  is 
more  profuse  in  weakness  than  in  vigorous  health,  in  towns- 

1  This  partly  foreshadows  Rouget's  theory  of  the  erectile  accumulation  of 
blood  in  the  pelvic  blood  vessels,  on  account  of  the  serpentine  flexures  of  the  ar- 
teries, and  of  hindrance  to  the  reflux  through  the  veins. 

-  Haller  Elements  of  Physiology,  1786.     (English  Translation,  vol.  2,  p.  183.) 

a  Loc.  cit.,  p.  241.  • 


SOURCES   OF   THE   MENSTRUAL   BLOOD.  II 

women  than  in  peasants.  The  local  cause  of  menstruation  is 
the  specific  direction  of  the  plastic  force  to  the  organs  of 
generation.  On  account  of  their  high  vitality,  menstruation 
may  exist  even  in  the  absence  of  any  general  abundance 
of  blood."  Wagner  (Handworterbuch,  Bd.  4.  p.  879.  1853), 
after  accepting  the  ovular  theory  of  menstruation,  unknown 
to  Burdach,  says :  "  The  blood  that  is  evacuated  at  the  time 
of  menstruation  contains  all  the  constituents  of  normal 
blood,  and  is  a  part  of  the  blood  which  circulated  in  the 
body.  It  is  an  excess  which  is  acquired  in  the  ('  Getriebe'} 
of  the  individual  life,  whose  formation  is  rendered  possible 
through  the  entire  mechanical  disposition  (anlage)  of  the 
body.  It  is  completely  analogous  to  the  formative  material 
elsewhere  employed  for  the  development  of  the  embryo. 
The  menstrual  flow  ceases  during  pregnancy.  The  excess, 
which  at  other  times  may  be  eliminated  without  danger  to 
the  individual  life,  which  indeed  must  be  eliminated,  under 
pain  of  multiple  disturbances,  now  serves  to  cover  the  in- 
creased expenditure."  '  "  The  evacuation  of  the  menstrual 
blood  is  nothing  else  than  the  elimination,  under  a  special 
form,  of  superfluous  productive  material."  The  author,  who 
considers  the  slight  hemorrhages  accompanying  the  rut  in 
some  of  the  higher  mammalia  to  be  completely  analogous  to 
menstruation,  observes  that  this  evacuation  is  confined  to 
mammalian  animals  because  in  them  the  ovum  is  so  small  as 
to  make  only  the  most  insignificant  demand  upon  the  plastic 
force,  and  this  therefore  remains  in  excess.  Astruc  declared 
that  the  blood  and  lymph  destined  for  the  nutrition  of  the 
foetus  is  derived  from  that  which,  previous  to  puberty,  had 
been  used  for  growth,  and  during  the  maturity  of  the  woman 
continually  accumulates  in  certain  veins  on  the  inner  surface 

1  Wagner  endeavors  to  show  that  the  weight  of  menstrual  blood  saved  during 
ten  months  gestation  exactly  equals  the  weight  of  the  foetus  at  term.  But  by  the 
utmost  stretching  this  can  only  be  found  by  admitting  that  ten  ounces  of  blood 
are  lost  at  each  menstruation,  which  is  evidently  too  much. 


12  THE  .QUESTION   OF   REST    FOR   WOMEN. 

of  the  uterus.  When  these  are  swollen  by  the  accumulation, 
they  protrude  into  the  uterine  cavity,  are  called  "  ccecal 
appendages,"  and  from  them  flows  the  blood  at  menstruation. 
Allan  Thompson,  writing  about  the  same  time  as  Burdach,1 
says  menstruation  is  to  be  regarded  as  the  means  for  relieving 
the  female  system  from  an  overplus  of  blood,  which  exists 
during  the  whole  time  that  it  is  capable  of  propagation.  It 
is  to  be  regarded  as  indicating  a  surplus,  but  not  constituting 
the  whole  amount  required  for  the  foetus.  For  as  only  five 
or  six  ounces  are  lost  at  each  menstrual  period,  only  fifty 
ounces  or  eight  pounds  (three  pounds  and  two  ounces  avoir- 
dupois) could  be  accumulated  in  the  ten  months  of  preg- 
nancy, whereas  the  foetus  weighs  from  six  to  ten  pounds. 
Capuron  attributes  the  theory  of  plethora  to  Galen,  and  dis- 
putes it.  He  himself  explains  menstruation  as  the  result  of  a 
general  shock  given  to  all  the  organism  and  especially  to  the 
womb,  to  dispose  it  to  conceive,  to  retain  the  germ,  and  to 
develop  it  during  pregnancy. 

It  may  therefore  be  confidently  asserted  that,  previ- 
ous to  the  discoveries  which  associated  menstruation 
with  the  clehiscence  of  ova,  this  peculiar  phenomena  was 
almost  universally  regarded  as  a  proof  of  an  excess  of  nutri- 
tive force  in  the  sex  upon  whom  devolved  the  greatest  cost 
of  reproduction.  From  Hippocrates  to  Burdach  (see  ut 
suprai,  this  presumed  excess  of  nutritive  force  in  women  is 
constantly  contrasted  with  their  deficiency  of  muscular  force 
as  compared  with  that  of  man,  and  with  the  arrest  of  the 
growth  which  is  continuous  in  children.  Menstruation__hi 
women,  muscular  force  in  man,  growth  in  children,  were  held 
tQ  be  more^oFTcsT  cxirct  trqrriT7dCTits'T6~mTc~an other.2  But 
in  1845,  with  the  establishment  o?  the  fact  of  spontaneous 
ovulation,  the  conditions  of  general  nutrition  upon  which 

1   Todd's  Cyclopedia,  Art.  Generation.      1836. 

5  Though  Hermann  considers  the  menstrual  fluid  to  be  the  exact  equivalent- 
is!  plastic  force — of  the  sperm. 


PERIODICITY   OF   MENSTRUATION.  13 

menstruation  could  be  supposed  to  depend  began  to  be  lost 
sight  of  in  comparison  with  the  remarkable  local  phenomena 
with  which  they  were,  asserted  to  be  exclusively  associated. 
The  congestion  of  the  ovary,  ripening  of  the  ovule,  effusion 
of  the  serum  and  blood  into  the  Graafian  follicle ;  its  rupture  ; 
the  escape  of  the  reproductive  cell ;  its  seizure  by  the  fimbriae 
of  the  Fallopian  tube ;  its  journey  along  the  oviduct  and 
descent  into  the  uterus ;  the  hyperannia  of  the  latter,  the 
turgesence  of  its  mucous  membrane,  the  rupture  of  its  blood 
vessels,  and  local  hemorrhage  ;  this  entire  succession  of  pro- 
cesses seemed  the  more  surprising  because  more  recently 
demonstrated,  and  to  cause  a  greater  perturbation  of  the 
economy,  because  occurring  at  intervals.  For  the  first  time 
the  periodicity  of  menstruation  began  to  be  considered  as  a 
morbid  circumstance.  Although  physiologists  pointed  out 
that  the  periodicity  of  menstruation  belonged  to  the  general 
law  of  vital  phenomena,1  as  earlier  rude  observations  had 
associated  it  with  the  periodicity  of  cosmic  phenomena,2 
clincians  came  gradually  to  look  upon  it  as  a  fact  which 
isolated  menstruation  from  all  other  physiological  processes, 
which  rendered  its  ordinary  course  dangerous,  its  derange- 
ments fatal,  and  itself  was  sufficient  to  make  any  utero- 
ovarian  disease  baffle  the  skill  of  the  physician.  Aran,  who 
disputes  the  ovular  theory  of  menstruation,  saw  in  the 
periodical  return  of  uterine  "congestions"  the  main  reason 
for  the  desperate  tenacity  of  uterine  disease — the  patient 

1  Dalton,  Treatise  on  Physiology,  p.  548.     Beclard,  Elements  de  la  Physio- 
logic, 1867.     Longet,  Traite  de  la  Physiologic. 

2  See  Mead,  De  imperio  solis  et  Lunae.     Darwin,  Descent  of  Man,  p.  204, 
vol.  II,  associates  it  with  periodical  alterations  of  nutrition,  to  which  were  sub- 
jected the  primitive  ascidian  ancestors  of  the  human  race,  from  the  lunar  revo- 
lutions of  the  tides.     "  All  vital  functions  tend  to  run  their  course  in  fixed  and 
recurrent  periods,  and  with  tidal  animals  the  periods  would  probably  be  lunar, 
for  such  animals  must  have  been  left  dry  or  covered  deep  with  water — supplied 
with   copious   food   or  stinted — during   endless   generations,    at   regular   lunar 
intervals." 


14  TIIK    QUESTION"    OF    REST    FOR    WOMEX. 

being  exposed  to  incessant  relapses  at  the  very  brink  of 
recovery.  In  the  same  spirit,  Courty  remarks  that  "men- 
struation" constantly  intervenes  to  produce  and  aggravate 
uterine  disorders  by  fluxion,  congestions,  and  critical  evacua- 
tion.1 Scan/.oni  says  that  during  a  chronic  mctritis,  every 
menstruation  offers  an  occasion  for  the  development  of  a  new 
acute  inflammation.2  Khvisch,  speaking  of  the  dcsquamation 
of  the  mucous  membrane  of  the  uterus  during  men- 
struation, observes:  "This  periodic  physiological  process 
determines  at  the  same  time  a  disposition  to  various 
anomalies  of  menstruation  ;"  3  and  again,  "Chronic  inflam- 
matory affections  of  the  uterus  are  almost  constantly  ag- 
gravated at  each  menstrual  period,  or  even  return  after 
thc\'  have  been  removed,  so  that  the  greatest  hindrance  in 
the  treatment  of  many  cases  of  metritis  is  the  repeated  men- 
strual congestion."4  Finally,  all  writers,  of  whom  some  have 
been  already  quoted,  who  call  menstruation  an  "  infirmity," 
base  the  epithet  mainly  upon  the  periodicity  of  the  hemor- 
rhage. "  It  is  a  constantly  recurring  infirmity  that  occupies 
about  seven  years  out  of  thirty  of  a  woman's  adult  life."  It 
would  seem  as  if  for  these  writers,  were  the  flux  continual, 
or  of  as  frequent  occurrence  as  defecation  or  micturition,  the 
idea  of  infirmity  would  be  abolished.  On  the  other  hand. 
Beigel/'  writing  in  most  recent  times,  and  after  investigations 
have  shown  the  "  periodical  congestion  of  the  uterus  to  be 
much  more  extended  in  duration  than  was  formerly  sup- 
posed," observes  that  "  menstruation  is  of  so  much  the  more 

1   Loc.  cit.,  p.  2S6. 

-   Die  Chronische  Mctritis.     1867.     (For  a  more  favorable  view  by  the  same 
author,  see  at  infra.) 

s  Mutterkrankheiten,  Ld.  I.  p.  4. 

Loc.  cit.,  p.  14.  This  is  equivalent  to  saying  that  the  greatest  obstacle  to 
the  cure  of  any  visceral  disease  is  the  continuance  of  the  functions  of  the  organs 
involved,  which  keep  up  hyperiemia  and  innervation.  The  fact  is  true,  but  not 
peculiar  to  uterine  pathology. 

0  Die  Krankheiten  der  weiblichen  Geschlechtorgane. 


DANGERS   OF   PHYSIOLOGICAL  PROCESSES.  1 5 

significance  in  relation  to  chronic  metritis  because  its  influence 
is  almost  uninterrupted.  In  the  most  favorable  cases  we  can 
only  suppose  ten  to  fourteen  days  rest,  and  that  is  not  quite 
certain.  This  continual  ebb  and  flow  of  circulation  of  the 
pelvic  organs,  constitutes  a  predisposition  to  the  develop- 
ment of  most  diseases  of  the  female  sexual  sphere."  "At 
the  time  of  menstruation  the  uterus  is  in  a  state  which  offers 
all  the  conditions  from  which  metritis  developes  itself."  1 

Thus  one  of  the  most  essential  apparent  peculiarities  of 
the  menstrual  process,  its  periodicity,  that  formerly  was  sup- 
posed to  indicate  a  periodical  increase  in  the  vital  forces  of 
the  female  organism,  has  come  to  be  considered  as  a  mark  of 
constantly  recurring  debility,  a  means  of  constantly  recurring 
exhaustion  demanding  rest  as  decidedly  as  a  fracture  or  a 
paralysis.  The  comparative  novelty  of  this  view  is  assuredly 
no  proof  that  it  is  erroneous.  Investigations  into  the  laws 
of  animal  organisms,  have  repeatedly  shown  them  to  be  far 
more  complex  and  more  delicate  than  had  been  imagined  by 
the  rough  common  sense  of  mankind.  The  nature  and 
urgency  of  the  perils  menacing  the  life  of  young  children,  of 
puerperal  women,  of  wounded  men,  have  only  recently  been 
demonstrated  with  sufficient  clearness  to  attempt  their 
prophylaxis.  The  dangers  have  been  proven  to  be  inherent 
in  crowds  of  habitual  circumstances  that  for  centuries  have 
been  regarded  with  indifference  or  accepted  with  complacency ; 
air,  supposed  to  be  healthful  has  been  proved  foul ;  water, 
believed  innocuous,  has  been  convicted  of  poison  ;  food, 
the  staple  support  of  entire  populations,  has  been  accused  as 
the  cause  of  their  most  desolating  epidemics ;  or  certain 
articles  of  food  considered  insignificant,  have  been  shown  to 
be  so  essential  that  'certain  diseases  are  specifically  correlated 
to  their  absence.2  Lucrative  trades  have  been  condemned  as 

1  The  same  might  be  said  of  the  stomach  during  digestion,  or  the  brain  dur- 
ing activity,  i.e.,  that  then  gastritis  or  meningitis  seemed  to  be  the  most  imminent. 

2  Vegetables  and  scurvy — Iodine  and  goitre. 


1 6  THE   QUESTION   OF   REST    FOR   WOMEN. 

incompatible  with  the  health  of  the  workmen  who  embraced 
them  in  ignorance  and  with  alacrity  ;  '  methods  of  work  and 
hours  of  work,  shown  to  be  deadly  in  their  influence  over  the 
laborers  upon  whom  the}-  were  imposed  ;*  and  gigantic  in- 
dustries are  revealed  as  reposing  upon  holocausts  of  human 
beings.  Indeed  it  maybe  said,  that  in  the  need  and  greed  of 
human  life,  all  the  conditions  of  human  existence  have  been 
trampled  upon  so  ruthlessly  that  the  marvel  is  that  it  has  so 
often  survived.  It  is  not  therefore  inconsistent  with  what  we 
know  of  the  acquirement  of  knowledge  about  the  most  ob- 
vious physical  conditions,  that  this  special  condition  of 
menstruation,  should  have  been  hitherto  misinterpreted  in 
regard  to  its  influence  upon  the  activity  of  the  persons  sub- 
jected to  it.  Although  not  yet  proved,  it  is  conceivable  that 
all  women  should  require  an  extra  rest  on  accountof  it,  as 
all  children  have  been  shown  to  require  extra  sleep  on  ac- 
count of  their  immaturity.  It  is  not  impossible  that  the 
organization  of  the  industrial  world  without  reference  to  this 
physiological  requirement,  has  been  at  least  as  great  a  hard- 
ship to  women,  as  inattention  to  requirements  of  ventilation 
and  drainage  have  proved  to  be  to  all  laborers.  It  is  scarcely 
more  improbable  to  ascribe  ill  health  of  women  to  neglect  of 
precautions  in  regard  to  this  physiological  process,  than  in 
regard  to  the  physiological  process  of  parturition  which  is  un- 
questionably the  starting  point  of  hosts  of  diseases,  and  the 
cause  of  death  to  about  one  woman  in  180.  A  line  of  argu- 
ment not  more  subtle  than  was  employed  by  Hahneman  in 
tracing  insanity  and  consumption  to  suppression  of  scabies, 
might  even  demonstrate  that  the  majority  of  all  cases  of  dis- 
ease in  the  female  sex,  resulted  from  prevalent  habits  in 
regard  to  the  menstrual  period,  the  minority  only  of  individ- 
uals escaping  the  legitimate  consequences  of  their  mode  of 
life,  on  account  of  some  exceptional  strength  of  constitution 

1   Cutlery— Lead— Phosphorus  factories. 
On  mine*,  (coal  and  quicksilver)  dressmakers,  factory  children. 


WOMEN   IN   INDUSTRY.'  I" 

But  if  these  hypotheses  be  true,  the  practical  consequences 
are  at  once  so  important  and  so  inconvenient,  that  they 
should  only  be  accepted  after  the  strictest  scrutiny.  It  is 
well  to  glance  for  a  moment  at  the  statistics  of  the  work  per- 
formed by  women  in  various  parts  of  the  world,  without  any 
attempt  to  secure  for  themselves  rest  during  the  menstrual 
period.  Leroy  Beaulieu,  in  his  prize  essay,1  has  shown  by  a 
few  well  selected  examples,  that  at  no  time  and  in  no  country 
have  domestic  occupations  absorbed  the  existence  of  the 
woman  in  the  working  classes  ;  that  this  ideal  society  where 
the  man  might  suffice  for  the  necessities  of  the  family,  and 
the  woman  only  be  obliged  to  look  after  the  house  and  the 
education  of  the  children,  has  never  existed  in  the  past ;  that 
whenever  a  branch  of  remunerative  employment  has  been 
open  to  women,  they  have  precipitated  themselves  upon  it 
with  avidity,  and  that  in  the  absence  of  industrial  pursuits, 
they  have  fallen  back  upon  occupations  coarser  and  less 
productive. 

"  The  workshop  existed  in  Europe  long  before  the  tenth 
century,  under  the  name  of  gynecee,  sometimes  attached  to 
the  house  of  the  lord  of  the  manor  and  under  the  direction 
of  his  wife,  sometimes  belonging  to  abbeys,  and  controlled 
by  a  superintendent.  In  convents  the  nuns  manufactured 
everything  needed  for  their  own  use,  then  for  sale  in  the 
world.  Spinning  and  dyeing  of  wodl  occupied  a  large  part 
of  their  days.  In  the  Registers  of  trades  and  merchandises 
of  Depping  is  proof  that  the  trades  corporations,  contrary  to 
a  prevalent  opinion,  were  arranged  to  include  women.  We 
find  mentioned,  workwomen  in  silk  cloths,  silk  spinners, 
weavers  of  kerchiefs,  embroideresses,  combers  of  wool,  silk 
hatters,  and  many  other  trades,  where  the  women  were  not 
only  admitted  as  aids,  but  might  become  mistresses,  or  even 
be  eligible  for  the  dignities  of  the  corporation.  The  history 
of  female  labor  in  epochs  nearer  to  us  would  be  the  history 

1  Le  Travail  des  Femmes  au  xix  Siecle,  1873. 
2 


IS  THE   QUESTION   OF    REST   FOR   WOMEN. 

of  industry  itself.  The  more  civilization  is  developed  and 
refined,  the  more  women  participate  in  production,  and  this 
participation,  constantly  greater  and  more  active,  is  regarded 
by  women  themselves  as  an  advantage."  In  1640,  a  decree 
of  the  parliament  of  Toulouse,  on  the  pretext  that  lace 
manufacture  carried  off  too  many  women  from  domestic 
occupations,  forbade  this  work  throughout  the  limits  of  its 
jurisdiction.  Thousands  of  workwomen  were  thus  deprived 
of  their  bread  until  the  decree  was  reversed.  Although  the 
occupations  of  women  under  the  old  regime  were  much  more 
numerous  than  is  generally  believed,  they  were  nevertheless 
too  little  for  the  necessities  of  the  women.  In  1/89  appeared 
the  petition  of  the  women  of  the  Third  Estate  to  the  king, 
in  which  they  claimed  for  their  sex  the  right  of  working 
without  (reglementary)  hindrance,  and  even  demanded  that 
all  trades  for  sewing,  spinning,  or  knitting  should  be  handed 
over  exclusively  to  them.  Thus  before  the  new  world  about 
to  open,  the  first  cry  of  the  women  was,  not  to  repudiate, 
but  to  invoke  labor,  not  to  decline  and  repulse  the  name  of 
workwomen,  but  to  claim  it  and  make  of  it  a  title  of  honor."  ' 
This  in  1/89.  In  1851  Paris  alone  contained  112,189  work- 
ingwomen,  of  whom  6o,OOO  were  employed  in  various  kinds 
of  needle-work.  In  1873  it  may  be  calculated  that  about 
400,000  or  450.000  women  are  employed  in  France  in  manu- 
factories of  cotton,  wool,  linen,  or  silk.  In  1861,  in  Great 
Britain,  the  textile  industries  occupied  467,261  women  and 
808,273  men,  or  about  three  women  for  every  two  men." 
In  1864 — we  continue  to  quote  Leroy  Beaulieu — in  1864  a 
total  of  747,261  women  were  engaged  in  the  industrial  estab- 
lishments of  Great  Britain.  Lord  Brougham,  in  a  speech 
before  the  Social  Science  Association  in  1862,  affirmed  that 
"  three-quarters  of  adult  unmarried  women,  two-thirds  of  the 
widows,  and  a  seventh  of  married  women,  are  occupied  in 
Great  Britain  on  independent  or  isolated  labors,  without 
1  See  also  Richter,  Recht  der  Frauen  auf  Arbeit.  1869. 


WOMEN   IN   INDUSTRY.  19 

counting  the  multitude  of  wives,  daughters,  and  sisters,  who 
share  in  the  work  of  their  relatives  at  the  counter,  in  the 
dairy,  or  by  the  needle." 

In  Germany,  Hirt  enumerates  female  laborers  in  manu- 
factories for  bronzes,  (Nuremberg)  pins,  gold  leaf,  glass  and 
porcelain,  wool,  flax,  tobacco,  paper,  straw  hats,  india  rubber, 
paints,  looking-glasses,  toys,  phosphorus  matches,  sugar 
refineries,  colors,  etc.,  etc.  In  the  United  States,  the  census 
for  1870  shows  that  out  of  9,750,000  females  above  ten  years 
old,  1,594,783  are  represented  on  tables  of  occupations  taking 
part  in  the  paid  industry  of  the  country.1  This  is  one-sixth 
of  the  entire  female  population.  Among  these,  373,832  are 
registered  as  agricultural  laborers,  and  of  these  the  immense 
majority  is  in  the  Southern  States,  and  probably  consists  of 
negroes,  who  for  our  purposes  may  be  excluded  from  the 
reckoning.  This  leaves  1,221,451  white  women  engaged  in 
work  of  sufficient  regularity  and  importance  to  render  the 
question  of  monthly  vacations  a  serious  one.  Of  these, 
22,681  are  farmers  and  planters,  mostly  in  the  Southern 
States,  but  amounting  to  1,027  in  Pennsylvania,  and  less  in 
some  of  the  others.  Professional  and  "  personal "  occupa- 
tions claim  1,066,672  out  of  the  1,198,270  remaining  after 
subtracting  the  agriculturists.  Manufactures,  353,950,  while 
trade  and  commerce  only  employ  18,698."  Under  the  head 
of  personal  and  professional  employments,  domestic  service 
ranks  much  the  highest  in  the  numbers.  It  enrolls  867,354. 
Afterwards  comes  the  profession  of  teaching  (84,047).  The 
next  in  order  is  the  business  of  keeping  boarding-houses, 
which  employs  7,060  women.3  The  only  other  classes  at  all 

1  The  number  recorded  as  keeping  house  is  7400,000,  thus  leaving  a  defi- 
ciency unaccounted  for,  i.e.  apparently  without  any  employment,  of  755,217,  or 
about  three-quarters  of  a  million.  ' 

1  This  opposition  between  manufacturing  and  commercial  industry  is  in 
direct  contradiction  to  the  theoretical  estimate  made  by  Mill,  that  women  should 
be  more  extensively  employed  in  distribution  than  in  production. 

a  A  priori,  we  might  have  expected  a  much  larger  number  under  this  head. 


20  TIIK    QUESTION    OF    REST    FOR    WOMEN. 

numerously  filled,  are  that  of  barbers  arid  hairdressers  (1,179) 
and  michvivcs  U,i86),  numbers  almost  equal  to  one  another.1 
Although,  therefore,  the  number  of  women  engaged  in  paid 
employments  is  in  all  countries  the  minority,  relatively  to 
the  entire  population,  yet  in  itself  the  number  is  immense. 
For  to  estimate  the  influence  of  steady  occupation  upon 
female  existence,  we  must  add  to  those  engaged  at  any  given 
time,  a  large  proportion  of  the  classes  who  do  not  then 
appear  on  the  tables,  but  are  registered  as  married  or  keeping 
house.  A  very  great  many  of  those  have  been  occupied  in 
paid  pursuits  previous  to  marriage,  and  from  the  statistics  of 
widowhood  in  England  and  America,  we  know  that  many 
are  destined  to  return  to  the  same  at  a  later  period  of  life. 
Tilt  has  pointed  out  that  the  tables  of  the  Registrar  General 
indicate  late  marriages  and  late  child-bearing  as  much  more 
frequent  than  is  generally  supposed.2  Since  marriage  and 
domestic  service  constitute  the  only  natural  equivalent  for  the 
paid  industry  of  women,  everything  which  delays  marriage 
tends  to  increase  the  extent  to  which  they  will  engage  in  non- 
domestic  professional  or  industrial  occupations,  and  the  reg- 
ulation of  their  labor  becomes  therefore  of  more  importance. 
In  Europe  very  much  more  than  in  America,  and  on  the 
continent  more  than  in  Great  Britain,  marriage  among  the 
laboring  classes  does  not  interrupt  industrial  life,  since  the 
earnings  of  the  woman  are  needed  for  the  support  of  the 
family.  "  It  is  unfortunately  evident,"  says  M.Simon,3  "  that 
if  the  average  wages  of  a  good  workman  are  two  francs  a  day, 
and  that  the  sum  needed  for  the  support  of  his  family  is  three 
francs,  the  best  advice  that  can  be  given  to  the  mother  is  to 
learn  a  trade  and  earn  the  requisite  twenty  sous.  This  con- 
clusion is  inexorable,  and  there  is  neither  theory,  nor  elo- 
quence, nor  sentiment,  which  can  resist  a  demonstration  of 

1  The  number  of  women  registered  as  physicians  is  between  five  and  six  hun- 
dred (we  forget  at  this  moment  the  exact  figure).  t 

2  Change  of  Life.     1857.    p.  19.  a  L'Ouvriere,  p.  12. 


INDUSTRIAL   WORK   OF  WOMEN.  21 

this  kind."  "  The  a  priori  character  of  the  family  organization 
as  derived  from  the  unequal  distribution  of  strength  between 
the  man  and  the  woman,  are  far  from  being  realized  in  actual 
life."  It  is  impossible  to  exclude  young  girls  from  manu- 
factures, our  industry  has  need  of  the  labor  of  woman  and 
women  are  in  imperative  need  of  the  salaries  afforded  by 
wholesale  industry."  '  The  preoccupations  of  philanthropists 
like  Simon,  are  concentrated  upon  the  demoralization  of  the 
family,  alleged  to  be  inevitable  when  the  mother  is  at  work 
out  of  the  house,  though  the  life  of  the  workshop  or  the  fac- 
tory is  not  deleterious  to  health,  indeed  both  more  hygienic  and 
more  remunerative  than  any  work  which  can  under  the  present 
system  be  carried  on  at  home.  On  the  other  hand  the  at- 
tention of  hygienists  like  Hirt,3  is  directed  almost  exclusively 
to  the  increased  number  of  abortions  and  higher  rate  of  infan- 
tile mortality  which  is  asserted  to  accompany  the  extended 
employment  of  married  women  in  factories.  The  author's  sug- 
gestion for  legal  interference  to  regulate  female  labor,  bears 
exclusively  upon  this  point,  and,  although  at  the  beginning 
of  his  essay,  he  classes  menstruation  with  pregnancy,  parturi- 
tion and  lactation,  in  its  tendency  to  diminish  the  industrial 
capacity  of  women,  yet  at  the  close  he  declares  impossible 
and  unnecessary  any  attempt  to  frame  regulations  in  accord- 
ance with  the  supposed  exigencies  of  this  physiological  pro- 
cess.8 

From  this  brief  glance  at  the  actual  condition  of  mod- 
ern society,  it  is  evident  that  its  existing  regulations  are  little 
prepared  to  "  yield  to  nature  her  inexorable  demand  for  rest 
during  one  week  out  of  every  four  "  in  the  adult  life  of 
women.  If  the  answer  to  the  question  asked  by  the  com- 

1  Leroy  Beaulieu,  Les  Travail  des  femmes  au  xix  siecle,  1873.     I  condense 
the  substance  of  several  scattered  remarks. 

2  Die  Gewerbliche  Thatigkeit  der  Frauen,  1873. 

3  The  quotation  made  by  Ames  (Sex  in  Industry)  from  the  first  page  of  Hirt's 
Essay,  conveys  an  impression  that  is  not  confirmed  by  Hirt's  conclusions. 


22  THE   QUESTION   OF   REST   FOR   WOMEN. 

mittee  be  in  the  affirmative,  a  revolution  in  industrial  cus- 
toms should  be  required  at  least  as  radical  as  those  enforced 
by  the  English  Factory  Laws  of  1842.  This  question  though 
apparently  simple,  is  in  reality  difficult  even  to  ask  with  pre- 
cision. Each  term  is  susceptible  of  various  shades  of  mean- 
ing. If  it  be  said,  "  It  is  necessary  that  women  rest  during 
menstruation,"  we  must  ask  necessary  for  j\vlia_t  purpose  ? 
The  preservation  of  life?  Evidently  not,  since  the  most 
superficial  observation  sho\vs  thousands  of  women  of  all  races 
and  ages  engaged  in  work  of  various  degrees  of  severity 
without  attempting  to  secure  repose  at  the  menstrual  epoch. 
But  in  regard  to  the  periodical  repose  of  sleep,  it  is  impos- 
sible even  to  imagine  that  it  should  be  secured,  at  least  to 
some  extent,  even  though  insufficiently.  It  is  indeed  super- 
fluous to  assert  that  any  condition  really  necessary  to  life, 
cannot  be  destroyed  except  under  penalty  of  death.  It  is, 
ho\vevcr,  conceivable  that  rest  during  menstruation  may  be 
necessary  for  the  attainment  of  a  high  standard  of  health,  or 
for  the  avoidance  of  certain  forms  of  disease.  The  average 
amount  of  diurnal  repose  is  a  tolerably  fixed  quantity,  the 
limits  of  whose  variations  are  known,  and  any  marked  trans- 
gression of  those  limits  is  certainly  followed  by  serious  deteri- 
oration of  health.  The  injury  is  severe  in  proportion  to  the 
immaturity  of  the  individual,  and  to  the  length  of  time  to  which 
he  is  exposed  to  the  deteriorating  influence.  If  the  necessity 
for  menstrual  rest  be  in  any  way  so  imperious  as  that  for  a 
fixed  amount  of  sleep,  it  must  follow  that  the  persons  de- 
prived of  the  one  will  suffer  as  certainly  and  proportionately 
as  those  robbed  of  the  other.  Moreover  it  should  be  made 
as  clear  in  the  one  case  as  in  the  other  that  the  condition 
examined  was  alone  sufficient  to  produce  the  deterioration  of 
health,  in  the  absence  of  all  the  other  circumstances  by  which 
it  is  habitually  complicated.  After  sifting  out  these  circum- 
stances as  completely  as  possible,  we  should  discover  a  strict 
correlation,  both  direct  and  inverse,  between  the  degree  of 


IMPORTANCE   OF   REST.  23 

health  attained  by  different  classes  of  women,  and  the  degree 
to  which  they  obtained  the  amount  of  menstrual  rest  ascer- 
tained to  be  the  necessary  average.  We  are  authorized  to 
expect  this  from  the  facility  of  establishing  such  a  correlation 
in  regard  to  sleep, — the  type  of  periodical  repose.  If  the  de- 
gree were  fixed  to  which  menstrual  rest  of  some  kind  may  be 
necessary  in  order  to  avoid  a  special  predisposition  to  disease, 
the  duration  of  that  rest  would  still  remain  to  be  determined. 
This  indeed  is  appreciated  by  the  committee  who  have  framed 
the  question  submitted  for  decision.  This  duration  might 
be  fixed  empirically,  that  is  by  ascertaining  the  number  of 
days  the  women  who  do  rest  habitually  claim  for  that  pur- 
pose ;  or  else  it  may  be  determined  theoretically  from  con- 
sideration of  the  succession  of  phenomena  that  constitute  the 
menstrual  process,  the  length  of  time  occupied  by  each,  and 
the  presumed  relations  of  each  to  the  rest  of  the  economy. 
In  regard  to  this  point,  a  very  slight  investigation  will  dis- 
close a  singular  discrepancy  between  the  claims  of  theories 
and  the  habit  of  practice,  and  also  between  the  inference 
that  may  be  derived  from  different  theories,  and  especially 
when  these  have  been  advanced  at  different  states  of  knowl- 
edge in  regard  to  the  physiology  of  menstruation. 

But  the  degree  of  rest  does  not  vary  merely  in  its  dura- 
tion relatively  to  that  of  the  menstrual  epoch,  but  in  its 
intensity  relatively  to  the  occupation  habitually  pursued.  It 
might  be  supposed  that  the  rest,  if  required  at  all,  must 
necessarily  be  complete,  in  proportion  to  the  strenuousness 
of  the  occupation.  It  is  certain,  however,  that  this  is  by  no 
means  the  case,  either  in  regard  to  physical  or  to  mental 
strain.  It  has  been  impossible  to  obtain,  as  we  had  hoped, 
a  complete  table  of  women  engaged  in  various  employments 
that  exacted  unremitting  attendance;  and  to  compare  the 
suffering  experienced  by  them  at  the  menstrual  epoch  with 
that  claimed  by  others,  whose  more  luxurious  mode  of  life 


24  THE   QUESTION   OF   REST    FOR   WOMEN. 

permitted  complete  repose.  But  some  data  have  been  pro- 
cured on  this  point  which  arc  far  from  useless. 

There  is  another  point  of  vie\v  from  which  this  question 
of  menstrual  rest  may  bp  considered.  If  the  working  capacity 
of  women  during  the  period  of  haemorrhage  be  really  and 
uniformly  diminished,  the  work  done  at  this  time  should  be 
expected  to  be  inferior  in  quality  to  that  performed  at  other 
times.  Since  at  any  given  time,  out  of  any  given  number 
of  women,  a  certain  proportion  will  always  be  found  men- 
struating, it  is  possible  that  the  average  inferiority  that  is 
ascribed  to  their  collective  work,  as  compared  with  that  of 
men,  may  be  explained  by  this  condition  peculiar  to  their 
sex,  which,  although  not  always  operative  upon  each  indi- 
vidual, is  always  influencing  women  considered  en  masse. 
Room  would  then  be  afforded  for  the  suggestion,  that  the 
quality  of  work  performed  in  non-menstrual,  i.e.  non-hemor- 
rhagic  periods,  would  be  raised  above  the  average,  if  an 
absolute  rest  from  work  were  observed  at  the  time  of  the 
menstrual  flow  ;  and  that  thus  the  quality  of  women's  work 
would  be  everywhere  raised  to  the  level  of  that  of  men's. 
This,  indeed,  is  the  formal  proposition  of  Dr.  Clarke  in 
relation  both  to  the  work  of  school-girls  and  to  the  industrial 
and  professional  work  of  adult  women.  This  suggestion  is 
plausible,  and  requires  all  the  more  careful  scrutiny,  lest  if  it 
be  not  in  accordance  with  the  real  facts  of  the  case,  it  should 
be  adopted  in  the  place  of  some  other  provision  for  rest 
which  is. 

The  question  proposed  by  the  committee  resolves  itself 
into  the  following  series  of  questions  : 

1.  What  proportion  of  women  habitually,  suffer  pain  or 
discomfort  of  any.  kind   during  any   part  of  the   menstrual 
period  ? 

2.  How  many  out  of  this  proportion  are  compelled  to 
suspend  their  ordinary  avocations  on  account  of  this  pain? 

3.  Is  there  any  uniform  relation  between  the   nature   of 


QUESTIONS   TO   BE   ANSWERED.  2$ 

the  occupation  and  the  necessity  for  its  interruption,  i.  e.  do 
some  occupations  more  frequently  necessitate  intermissions 
than  others  ? 

4.  Among  women  who,  on  account  of  immunity  from 
menstrual  pain,  have  never  been  in  the  habit  of  resting  at 
the  menstrual  period,  are  there   any  considerable   number 
whose   health    has    progressively   deteriorated   without   the 
presence  of  any  other    condition  that  could  be  assigned  as 
the  cause  of  such  deterioration  ? 

5.  What   is    the    real  succession  of   phenomena  in  the 
menstrual  process,  and  what  relation  does  it  bear  to  the  other 
processes  of  the  economy  ? 

6.  This   relation    established,  what    inferences  in  regard 
to  women's  capacity  for  work,  should  be  theoretically  deduced 
from  it  ? 

7.  If  discrepancies  exist  between  the  practical  statistics 
and  theoretical  inference,  how  are  they  to  be  explained  ? 

8.  Finally,  do  either  facts  or  theory  point  to  any  hygi- 
enic rules  exclusively  applicable  to  the  work  of  women? 


SECTION    II. 

STATISTICS. 

THE  answer  to  this  first  question,  if  asked  without  dis- 
tinction of  age,  constitution,  family  history  or  occupa- 
tion, is  not  very  difficult  to  obtain  ;  although  considerable 
time  must  often  be  expended  upon  inquiry.  The  statistics 
obtained  by  Brierre  de  Boismont  and  frequently  quoted,  are 
compiled  from  three  hundred  and  sixty  women.  Of  these, 
two  hundred  and  seventy-eight  suffered  various  degrees  of 
colic,  some  very  slight,  at  the  menstrual  period  (77  per  cent.); 
while  eighty-two  enjoyed  complete  immunity.  This  is  less 
than  23  per  cent.  In  regard  to  general  symptoms,  three 
hundred  and  thirty-four  women  were  questioned,  replies  are 
given  from  two  hundred  and  twenty-three  ;  of  whom  181  de- 
clared that  they  were  conscious  of  no  change  during  menstru- 
ation, while  forty-three,  about  one-fifth,  admitted  that 
menstruation  was  a  period  of  suffering,  especially  nervous  or 
moral.  These  brute  statistics  have  precisely  the  same  value 
as  the  empirical  formula  of  a  compound  substance  submitted 
to  elementary  analysis.  The  rational  formula  can  only  be 
obtained  by  comparing  the  single  datum,  pain  or  not  pain, 
with  a  variety  of  other  circumstances.  In  order  to  do  this 
effectually,  we  have  prepared  the  following  table  of  questions, 
each  of  which  was  to  be  answered  by  the  person  replying  to 
the  one  question  in  regard  to  pain. 

The  undersigned,  desirous  of  collecting  reliable  statistics  in  regard  to 
the  menstruation  of  women  in  America,  would  feel  indebted  to  all  ivho 
would  answer  accurately,  the  following  questions. 

No  signature  is  necessary. 


CIRCULARS.  27 

1.  Age  of  going  to  and  of  leaving  school. 

2.  Health  under  13.     Specify  any  disease  of  parents  or  sisters. 

3.  Number  of  hours  a  day  spent  in  study  at  school. 

4.  Hours  spent  in  exercise  every  day  during  same  period. 

5.  Studies  pursued  between  ages  13  and  leaving  school. 

6.  Occupation  (if  any)  since  leaving  school,  and  hours  of  work. 

7.  Health,  general,  since  leaving  school.     Specify  date  of  any  illness. 

Do  you  have  headache  or  neuralgia  ? 

8.  Date  of  first  menstruation. 

9.  Pain  at  menstruation,  while  at  school  and  since  leaving. 

10.  Does  pain  occur  before,  during,  or  after  flow?     Spasmodic,  cramp- 

like,  or  steady  and  burning  ? 

11.  Does  pain  exist  between  menstrual  periods? 

12.  What    is    duration   of   flow?     Has   it   ever    been   excessive   or  too 

scanty  ? 

13.  Has  it  been  necessary  to  rest  during  period  ?    If  so,  how  long?    When 

did  this  first  become  necessary  ? 

14.  Strength,  as  measured  by  capacity  for  exercise.     How  far  can  you 

walk  ? 

15.  Have  you  ever  been  treated  for  uterine  disease  ? 

1 6.  Are  you  thin  or  stout,  rosy  or  pale,  tall  or  short?     Has  any  change 

taken  place  since  twenty  in  color,  flesh,  or  strength  ? 

Although  a  thousand  of  these  tables  were  prepared  for 
circulation,  we  have  only  been  able  to  obtain  up  to  this  date 
two  hundred  and  sixty-eight  answers.  Out  of  this  number, 
ninety-four  persons  record  themselves  as  never  having  suf- 
fered either  pain,  discomfort,  or  weakness  during  the  men- 
strual flow.  This  is  35  per  cent,  of  the  whole — less  than 
one-half,  but  more  than  the  percentage  given  by  Brierre  de 
Boismont. 

The  total  number  of  cases  divide  themselves,  therefore, 
into  two  classes,  each  of  which  must  be  separately  analyzed. 
Of  the  first  class  (those  who  have  not  suffered  pain),  the  fol- 
lowing table  presents  the  statistics  in  regard  to  attendance 
at  school : 


28 


THE   QUESTION   OF   REST   FOR   WOMEN. 


TABLE   I.— SCHOOL   ATTENDANCE.     (GROUP  i.) 


Ape  at 
Beginning. 

Xo.  Cases. 

Age  of  Leaving. 

Xo.  Cases. 

Hours  of  Study. 

Xo.  Cases. 

2  years. 

I 

12  years. 

I 

4  hours. 

2 

" 

4 

13       " 

I 

5       " 

13 

4 

7 

14 

4 

6      " 

36 

5      " 

12 

6 

7       u 

10 

6      " 

15 

16 

16 

S      " 

8 

7       " 

15 

17 

ii 

10        " 

i 

8      " 

10 

iS 

6 

Not  specified. 

iS 

_ 

8 

9 

10        ' 

2 

20 

6 

ii 

2 

g 

21 

2 



12 

Not  specified. 

15 

25 

2 

2? 

I 

3° 

I 

4 

specified. 

i^ 

Total  

94 

Total    

89 

Total   

S3 

This  table  shows:  i.  That  the  great  majority  of  persons 
of  whom  we  have  been  able  to  obtain  statistics  have  attended 
school  during  a  number  of  years. 

2.  That  school  attendance  begins  at  the  age  of  five,  six, 
seven,  or  eight,  in  about  the   same   number  of  persons,  and 
these  collectively  are  52,  or  55^  per  cent,  of  the  whole  num- 
ber (94)  of  whom  the  earliest  date  of  attendance  is  specified. 

3.  The   age   of  leaving  school,   or   rather   of  ceasing    to 
study,   varies  much   more.     The    greatest   number,   sixteen, 
leave  at   the  age   of  sixteen.     This  is  nearly  18  per  cent,  of 
the  whole  number  recorded  (89).     The  next  age  in  point  of 
frequency  is  seventeen,  where  the  number  of  persons  is  1 1,  or 
12  per  cent.     The  next  is  nineteen,  with  a  record  of  eight  or 
nearly  nine  per  cent,  while  the  ages  of  fifteen   and    eighteen 
give  the   same   number,  six  or  nine  per  cent.     This   coinci- 

1  It  will  be  seen  that  the  figures  of  totals  on  the  tables  are  not  always  identi- 
cal. This  is  because  all  the  questions  asked  in  the  circular  are  not  answered  in 
each  response. 


ANALYSIS   OF   TABLE   I.  29 

dence  is  probably  accidental,  and  of  no  significance  in  the 
small  number  of  figures  operated  upon.  But  the  ages,  fifteen, 
sixteen,  seventeen,  eighteen,  and  nineteen,  represent  col- 
lectively the  age  of  cessation  of  study  for  forty-seven 
persons,  or  over  52  per  cent,  of  the  whole  number  speci- 
fied (64). 

4.  The  nine  persons  who  are  stated  to  have  left  school  at 
ages  of  twenty-two,  and  over  four  at  twenty-two,   one  at 
twenty-three,  two  at  twenty-five,  one  at  twenty-seven,  one  at 
thirty,  were  all   engaged   in   professional   studies,  and   their 
number  should  therefore  be  added  to  the  four  of  which  this 
was  specified,  making  a  total  of  thirteen,  or  a  percentage  of 
fourteen. 

5.  No  average  has  been  calculated  for  the  number  of 
years  passed  at  school  or  in  study,  for  no  useful  purpose 
would  be  served  by  it.     But  the  persons  who  are  represented 
as  beginning  school  early  do  not  cease  attendance  any  earlier 
than  the  others.     Thus  of  the  thirteen  who  began  to  go  to 
school  at  the  age  of  five,  two  left  at  fifteen,  three  at  sixteen, 
two  at   seventeen,  one  at   eighteen,  one  at  twenty,  one  at 
twenty-one,  one  at  twenty-two,  one  at  twenty-five,  and  one  is 
not  specified  ;  and  of  the  nine  persons  who  began  school  at 
the  age  of  two,  three,  or  four,  two  went  until  seventeen,  two 
until  eighteen,  one  until  twenty,  and  one  until  twenty-four, 
or    two-thirds   of    the    whole    ceased    at  a  later  age    than 
the   average,   the   remaining    three   somewhat    earlier    (14, 
IS,  1 6). 

Early  attendance  at  school  is  not  to  be  regarded  as  proof 
of  very  precocious  forcing  of  the  intelligence,  for  the  studies 
pursued  are  rarely  stimulating,  or  beyond  the  intelligence  of 
American  children.  But  the  confinement  of  school  hours 
for  children  under  nine  years  of  age,  is  a  circumstance  of 
serious  moment  in  the  hygienic  history  of  women.  Among 
those  for  whom  the  age  of  beginning  school  is  specified, 
seventy-one  began  school  at  nine  years  old  or  under  (75  per 


30  THE   QUESTION   OF   REST   FOR   WOMEN. 

cent.).  Of  these,  only  one.  who  went  to  school  from  the  age 
of  four  to  eighteen,  is  said  to  have  studied  only  four  hours 
during  the  early  childhood.  Of  the  others,  eighteen  are  said 
to  have  studied  five  hours  a  day,  and  thirty-six  six  hours. 
This  is  51  per  cent,  of  those  recorded. 

It  is  certain  that  this  amount  only  covers  the  time 
actually  spent  at  the  school-hours,  whose  sessions  are  habit- 
ually either  five  hours  or  six.  But,  except  for  the  youngest 
children,  this  session  is  always  supplemented  by  at  least  two 
hours  study  out  of  school,  and  this  is  acknowledged  by  ten 
persons,  who  record  themselves  as  studying  seven  hours  a 
day. 

Let  us  compare  now  the  amount  of  exercise  taken  by  the 
children  and  young  girls  who  sustained  this  amount  of 
sedentary  confinement. 

TABLE   II      EXERCISE.     (GROUP  i.) 


One  Hour  or 
one     and   a 
half. 

Hours. 

Three 
Hours. 

Four 
Hours. 

Five  or  Six 
Hours. 

All    out   of 
School. 

Irregular  or 
Unknown. 

12 

IS 

II 

15 

4 

4 

25 

Out  of  eighty-six  cases  in  which  the  exercise  is  recorded, 
forty-nine  exercised  two  hours  and  over,  or  57  per  cent., 
while  37,  01*42  per  cent,  exercised  insufficiently  or  irregularly. 
This  is  probably  the  case  with  two  others  who  arc  not  speci- 
fied. If  we  include  among  those  who  exercised  insufficiently, 
all  who  exercised  two  hours,  we  have  a  total  of  52,  or  59  per 
cent,  instead  of  42,  and  34,  or  38  per  cent,  who  seem  to  have 
had  abundant  exercise. 

The  object  of  the  Sth'question  in  the  circular  is  to  ascer- 
tain as  far  as  possible  to  what  extent  mental  strain  had  ex- 
isted during  the  period  of  the  establishment  of  menstruation, 
and  to  distinguish  its  influence  from  that  of  prolonged  seden- 


TABLE   II. 


tary  occupation  or  of  deficient  exercise.1  The  studies  are 
therefore  compared  with  the  hours  of  exercise. 

By  the  higher  English  branches  are  meant  History,  Rhet- 
oric or  Logic,  Philosophy,  Literature;  by  Mathematics,  Al- 
gebra, Geometry  or  Trigonometry,  one  or  all ;  by  natural 
sciences,  Botany,  Chemistry  or  Physiology.  It  is  probable 
that  in  the  majority  of  cases  these  latter  studies  at  least  were 
extremely  superficial. 

From  a  detailed  table,  specifying  the  exact  studies  in  each 
case,  we  have  prepared  the  following  condensed  table.  The 
studies  grouped  as  "Ornamental,"  indicate  the  scheme  of 
education  most  common  among  the  well-to-do '  classes  in 
cities,  which  includes  French,  sometimes  German,  Music  and 
Drawing,  but  excludes  Latin  and  Mathematics.  The  so- 
called  "  Higher  Education,"  includes  these.  The  studies  in 
Natural  Sciences,  except  in  a  few  cases  of  medical  students  (by 
no  means  in  all  of  these),  can  scarcely  be  considered  superior. 

TABLE  II.     STUDIES  AND   EXERCISE.     (GROUP  i.) 


.  Common  Ed. 

Ornamental. 

Higher. 

Exercise   after    13. 

2O  or 

14  or 

42  or 

Common. 

2  Hrs.  and  over 
7  cases, 
under,2  13. 

26J 

iSJ 

55J 

Ornamental. 

2  Hrs.  and  over 
ii  cases, 
under,  13. 

per  cent. 

per  cent. 

per  cent. 

Higher. 

2  Hrs.  and  over 
26  cases, 
under,  16. 

The   table   shows    that    of   seventy-six    cases   specified, 
twenty  only  studied  the  common  English  branches,  and  were 

1  These  two  conditions  are  far  from  identical,  since  abundant  exercise  and  even 
prolonged  schooling  are  far  more  healthful  than  short  school  hours,  but  inaction 
outside  of  them.  This  point  will  be  dwelt  upon  later. 

-  i.  e.  under  two  hours. 


32  THE    QUESTION*   OF    REST    FOR    WOMEN. 

among  the  first  to  leave  school ;  forty-two  took  a  full  course 
of  studies,  that  is  as  estimated  by  the  existing  standard 
for  "-iris"  education,  and  which  includes  Latin  and  the  higher 
mathematics,1  while  fourteen  took  an  ornamental  course, 
without  Latin,  and  principally  devoted  to  music  and  the 
modern  languages.  Of  the  first  twenty  who  only  had  a  com- 
mon English  education,  only  seven  exercised  daily  two  hours 
and  over,  thirteen  under  two  hours,  or  quite  indefinitely. 

Of  the  second  group  of  forty-two,  twenty-six  took  suffi- 
cient exercise,  (2,  3,  or  4  hours)  sixteen  insufficient,  (under 
2  hours.) 

Of  the  third  group  of  fourteen,  eleven  are  recorded  with 
sufficient  exercise,  three  with  insufficient. 

The  proportion  of  these  who  exercised  to  those  who  did 
not  is  in  the  first  group,  =  36  per  cent,  to  63  per  cent. 

In  the  second,  =  59  per  cent,  to  38  per  cent. 

In  the  third,  =  /S  per  cent  to  21  per  cent. 

If  any  conclusion  could  be  drawn  from  these  figures,  it 
would  be  that  the  ordinary  "  Ornamental  "  system  of  educa- 
tion, was  that  found  to  be  most  compatible  with  important 
hygienic  conditions.  But  the  fact  that  in  the  class  of  pain- 
lessly menstruating  women,  only  the  smallest  number  had 
pursued  this  system  of  education,  is  a  counter-fact  that  much 
diminishes  the  significance  of  the  first. 

The  sixth  question  is  intended  to  ascertain  the  effect 
upon  the  menstrual  health  of  the  occupation  pursued  after 
leaving  school.  It  was  hoped  that  the  answers  to  this  ques- 
tion would  cover  a  wide  range  of  employments,  but  they  are 
on  the  contrary  very  limited.  This  is  owing  to  the  great  diffi- 
cult}- of  obtaining  answers  from  women  of  the  industrial 
classes,  unless  during  a  medical  consultation,  when  they 
are  of  course  sick,  and  to  be  excluded  from  a  table  of 
healthy  cases. 

'  1-rom  enumeration  of  the  names  of  studies  pursued,  a  false  impression  would 
be  conveyed  that  these  were  much  more  arduous  than  in  truth  was  the  case. 


TABLE   III. 


33 


TABLE  in.— OCCUPATIONS.    (GROUP  i.) 


Married. 

Social  and 
Housework. 

Teaching. 

Other  employ. 

Married  and 
Employed. 

Literary  =  3 

27,  or  29| 

Medicine  =  8 

23,  or 

.... 

per  cent. 

Factory  =  4 

"'6 

.... 

Clerk  =  I 

25  per  cent. 

.... 

.... 

Business  =  I 

9,  or 

Machine  work  =  I 

8  per  cent. 

Servants  =  3 

.... 

.... 

Study  =  3  +  5  =  8 



Matron  =  I 

13  +  6  =  19,  or 



Total,  13 

20  per  cent. 

Among  the  married  women  it  was  interesting  to  ascertain 
the  number  of  children  born.  Adding  to  the  twenty-three 
married  and  devoted  to  household  duties  exclusively,  the  six 
who  continued  teaching,  literature,  or  medicine,  after  mar- 
riage and  childbirth,  we  have  : 


One. 

Two. 

Three. 

Four. 

Five. 

Six. 

Seven. 

Eight. 

Nine.      Ten. 

None. 

3 

7 

4 

I 

3 

2 

I 

5 

Thus  twenty-one  women  bore  children,  five  were  child- 
less ;  in  three  cases  questions  not  answered. 

Among  the  twenty-one  mothers  the  pregnancies  were 
nearly  all  favorable. 


An  important  question  is  the  fourteenth,  regarding  the 
amount  of  exercise  of  which  the  women  are  capable  who  are 
free  from  menstrual  disorder.  The  following  table  shows 
that  by  far  the  greatest  number  of  persons  in  this  class  are 
capable  of  considerable  physical  exertion,  and  even  take  a 
good  deal  of  exercise  habitually. 


TABLE   IV. 


Able  to  walk  from  3  to  15  miles 
Walk  2  miles  or  under. . . 


3-? 


THE   QUESTION   OF   REST    FOR   WOMEN. 


The  majority  of  persons  in  the  first  class  claim  to  be  able 
to  walk  five  or  six  miles  with  ease  at  any  time,  and  ten  or 
fifteen  when  called  upon  to  do  so,  especially  during  summer 
vacations  in  the  country. 

The  percentages  arc  respectively  79  and  21. 

Having  ascertained  that  ninety-four  women  out  of  our 
total  list  of  two  hundred  and  fifty-two  do  not  suffer  pain  or 
disturbance  at  the  menstrual  period,  it  is  necessary  to  learn 
whether  this  had  been  avoided  by  the  habit  of  resting  at  that 
time.  Also  whether,  in  the  absence  of  rest,  but  with  habit- 
ually normal  menstruation,  uterine  diseases  had  ever  occurred. 
Finally,  whether  this  class  of  persons  had  lost  or  gained  in 
health  since  the  age  of  twenty.  This  question  has  no  sig- 
nificance for  women  under  thirty,  but,  as  we  shall  see  in 
analyzing  the  cases  of  disturbed  menstruation,  it  is  of  much 
importance  at  or  after  that  age.  Questions  13,  15,  and  16 
were  framed  to  meet  these  indications.  Out  of  the  total 
number  of  ninety  answers,  the  following  alone  were  other 
than  negative  : 

TABLE   V. 


Habit  of  resting. 

Treated  for  uterine 
disease. 

Change  in  health  since  20. 

Increased  strength. 

Diminished  strength. 

9,  or  10  per  cent. 

3 

10 

8 

From  this  table  it  could  certainly  not  be  inferred  that  the 
immunity  from  menstrual  pain  was  due  to  the  habit  of  rest- 
ing during  the  menstrual  flo\v,  for  such  habit  existed  in  only 
a  small  minority  of  the  cases.  Among  the  nine  persons  in 
the  habit  of  resting,  the  duration  of  the  rest,  and  the  reasons 
for  taking  it,  were  very  various,  as  shown  by  the  following 
table  : 


TABLESS— CHOOLING   SECOND   CLASS. 


35 


TABLE  VI. 


No. 

Duration  of  rest. 

Remarks. 

13 
62 

First  day. 
Whole  week. 

To  avoid  dyspepsia. 
To  avoid  aggravation  of  chronic 

dyspepsia  resulting  from  dila- 

tation of  stomach. 

8l 

Sometimes  half  a  day. 

63 

Whole  week. 

Extremely  nervous  person,  sub- 

ject to  prolonged  hay  asthma 

debility. 

71 

Whole  week. 

Anemia  after  diphtheria  and  two 

confinements. 

85 

Seldom. 

39 

An  hour. 

88 

First  day. 

82 

Only  during  two  years  while 

suffering  from  "  ulceration  " 

of  uterus. 

We  must  now  analyze  one  hundred  and  seventy-four 
cases  in  which  menstruation  was  painful,  or  presented  some 
anomaly  in  regard  to  quantity  or  regularity.  We  will  first 
compare  these  cases,  as  far  as  possible,  with  those  of  the  first 
class,  in  a  series  of  tables  similar  to  those  already  framed.  One 
hundred  and  seventy  cases  are  represented  on  the  first  table. 

TABLE  VII.— OF  ATTENDANCE  AT  SCHOOL  OF  SECOND  CLASS. 


Age  of  beginning 
school. 

No. 

Age  of  leaving 
school. 

No. 

Hours  of 
study. 

No. 

2  years. 

I 

12  years. 

I 

2 

2 

3      " 

8 

13       " 

2 

4 

3 

4 

18 

!4        ' 

8 

5 

5      " 

22 

15      " 

6 

20 

6      " 

19 

16      " 

18 

'6 

49 

7 

27 

17      " 

29 

7 

17 

8      " 

16 

18      " 

26 

8 

12 

9      " 

9 

19      " 

14  . 

9 

II 

10        ' 

i 

20       " 

8 

10 

2 

IT 

i 

21        " 

3 

12 

I 

12 

3 

22        " 

4 

17 

i 

23        " 

i 

24        ' 

2 



25      " 

3 

.. 

30        ' 

i 

•• 

Total  

127 

Total    

126 

Total  

"7 

36  THE   QUESTION   OF    REST    FOR   WOMEN. 


10 

,.,      I 

43 

1  a  

Tritil       I    11  -4-  T"7  )  — 

170 

Additional  to  above,  with  special  remarks: 


49. 

60 
53 
69 
84 
SS 
94 
103 
105 


from   9-10,  and   from    15-16,  then   until    18.     Study  hours 
•e  9-10. 
:ed  at  home. 

.ed  at  home.      3-4  hours  study  daily. 
L'te  literary  and  medical  course. 
Ued  at  medical  college, 
liours  vary  from  4  to  12. 
iption  scliool  between  i3  and  21. 
iool  between  10  and  19,  then  for  i^  years. 
ed  school  from  13  to  17,  then  from  21  to  24. 
led  at  home  till  15,  then  school  to  iS,  now  till  2O. 


Comparing   item  by  item  this  table  with  the  correspond- 
ing table  in  the  first  class  we  find  : 

1.  That  a  large  majority  of  the  number  attended  school 
for  a  number  of  years,  spending  a  number  of  hours   daily  in 
study,  but  a  considerable  minority,  whose  attendance  is  not 
specified,  received    very  little    education  ;     thirty-one  cases, 
drawn  from   personal  observation,  have  been  ranked   in  this 
way,  and  in  the   additional   table   for   special  remarks,  it  ap- 
pears that  out  of  the  ten  cases,  one  was  educated  at  home, 
with  three  to  four  hours  daily  stud}',  one  did  not  go  to  school 
until  fifteen,  and  four  sustained  interruptions  in  their  studies 
of  several  years.     The  proportion  of  persons  whose  schooling 
has  been  slight,  is  much  larger  therefore  in  the  second  class, 
that  is  among  those  whose  menstruation  is  painful,  than  in 
the  first  where  it  is  not  painful,  170:   31  =  18  per  cent. 

2.  Among  the  cases  where  this  is  specified,  the  age  of 
beginning  school  is  as  in  the  first  table,  principally  between 


ANALYSIS   OF   TABLE  VII.  37 

five  and  eight.  But  the  proportion  who  begin  at  this  epoch 
is  smaller  than  in  the  first  class,  being  74  or  nearly  59  per 
.  cent,  instead  of  69.  The  per  centage  to  the  entire  number 
(170)  is  43.  On  the  other  hand  the  proportion  of  those  who 
began  to  go  to  school  under  five,  is  larger,  being  27  or  21  per 
cent,  (15  per  cent,  of  the  whole  number  170)  while  in  the  first 
table  it  is  12,  or  13  per  cent.  The  number  of  persons  who 
first  went  to  school  at  two  years  or  over,  is  only  13,  or  less 
than  12  per  cent,  (17  per  cent,  of  the  whole)  while  in  the  first 
class  it  is  15,  or  17  per  cent. 

3.  The  age  of  leaving  school  differs  from  that  of  the  first 
table.     The  greatest  number  recorded,  twenty-nine,  leave  at 
seventeen  instead  of  sixteen.     This  is  22  per  cent,  of  those 
specified,  nearly  the  same  propprtion  as  left  a  year  younger  in 
the  first  table.     But  of  the  whole  number  (169)  it  is  only  17 
per  cent.     The  next  age  in  frequency  is  eighteen,  when  the 
number  is  twenty-six,  or  20  per  cent,  (18  per  cent,  of  whole) 
and  fourteen  persons  or  1 1   per  cent,  do  not  leave  till  nine- 
teen.    The  percentage  of  this  age  is  thus  but  little  over  that 
on  the  first  table,  and  calculated   on  the  whole  number  is 
less,  being  8  per  cent.     But  the  ages  seventeen  and  eighteen 
furnish  collectively,  55  or  43  per  cent,  (32  per  cent,  of  whole) 
while  on  the  first  table,  the  same  ages  give  only  24  per  cent. 
In  this  class  therefore,  the  proportion  of  persons  who  leave 
school  late  is  much  larger  than  in  the  first  class.     The  ex- 
cess of  schooling,  however,  is  only  for  one  year,  and  does  not 
extend  beyond  the  age  of  eighteen,  percentage  for  nineteen, 
being  nearly  identical  on  the  two  tables. 

4.  Only  eleven  persons  are  recorded  as  pursuing  studies 
to  or  beyond  the   age  of  twenty-two,  a  percentage  of  8f 
against  a  percentage  of  16  on  the  first  table  (6  per  cent,  of 
the  whole).     This  comparison  shows  that  while  the  duration 
of  primary  and  secondary  education  was  more  prolonged  in 
the  second  class  than  in  the  first,  the  proportion  of  what  may 
be  presumed  to  be  comparatively  advanced  studies  was  twice 


THE   QUESTION   OF    REST    FOR   WOMEN. 


or  nearly  three  times  as  large  in  the  first  class  as  in  the 
second. 

5.  The  number  of  hours  spent  in  study  during  school  life 
is  about  the  same  as  in  the  first  table.  This  was  to  be  ex- 
pected from  the  uniformity  of  the  school  routine  to  which 
American  girls  are  subjected.  Forty-nine  are  said  to  have 
studied  six  hours  a  day.  This,  however,  is  only  39  per  cent. 
of  those  specified,  or  22  per  cent,  of  the  whole,  while  on  the 
first  table  this  number  covers  51  per  cent,  of  those  specified, 
or  43  percent,  of  the  whole.  Twenty-five  persons,  that  is,  19 
per  cent,  of  the  specified  cases,  or  14  per  cent,  of  the  whole, 
studied  less  than  this,  the  majority,  (20)  occupying  five  hours. 
This  proportion  is  sensibly  the  same  as  that  of  the  first  class, 
(18  percent,  of  those  specified,  15  percent,  of  the  whole). 
Forty-three  persons  are  said  to  have  studied  seven  hours  and 
over,  of  whom  three  claim  to  have  thus  spent  from  ten  to 
twelve  hours  daily.  These  then  were  among  those  whose 
studies  were  continued  after  age  of  twenty-one.  This  pro- 
portion is  33  per  cent,  of  those  specified,  or  25  per  cent,  of 
the  whole.  In  the  first  class  the  percentages  are  26  and  22, 
a  good  deal  less. 

The  next  table  shows  the  amount  of  exercise  taken  by 
girls,  in  whom  this  was  specified. 

TABLE    VIII.     EXERCISE    OF    SECOND    CLASS. 


Half 
Hour. 

One 
Hour. 

Hours. 

Three 
Hours. 

Four 
Hours. 

Five  or  Six 
Hours. 

All  out  of 
School. 

Indefinite. 

13 

30 

29 

17 

10 

T3 

I  r 

46 

Out  of  the  one  hundred  and  sixty-nine  cases,  eighty,  or 
47  per  cent,  are  said  to  have  exercised  two  hours  or  over, 
and  eighty-nine,  or  nearly  50  per  cent,  have  exercised  irreg- 
ularly or  insufficiently.  The  proportions,  therefore,  are  ex- 
actly the  reverse  of  those  of  the  first  class,  which  we  have 


ANALYSIS   OF   TABLE  VIII.  39. 

found  to  be  respectively  57  and  42  per  cent,  (see  page  30.) 
Now  for  children  and  young  girls,  two  hours  must  certainly 
be  considered  as  the  very  minimum  of  exercise,  admissible  as 
hygienic.  In  the  second  class,  it  represents  much  the  largest 
number  of  cases  among  those  who  can  be  considered  to  have 
exercised  at  all,  namely  29,  as  compared  with  17,  10,  13  and 
11,  while  in  the  first  class  the  number  15,  of  those  who  exer- 
cised two  hours,  is  equalled  by  those  who  exercised  four. 
In  the  first  class  the  percentage  of  persons  exercising  three 
hours  and  over  is  38,  while  in  the  second  class  it  is  only  30. 
It  is  clear,  therefore,  that  as  a  whole,  the  amount  of  exercise 
taken  during  school  life  by  persons  who,  at  any  age,  became 
subject  to  painful  menstruation,  is  inferior  to  that  taken  by 
those  who,  up  to  date,  were  perfectly  free  from  menstrual  in- 
convenience. The  absolute  figures,  however,  80  and  89,  are 
sufficiently  near  alike  to  necessitate  a  closer  analysis.  Among 
the  one  hundred  and  sixty-nine  cases  here  grouped  together 
as  suffering  from  menstrual  pain,  the  degree  of  suffering,  the 
age  at  which  it  first  occurred,  and  the  concomitant  circum- 
stances of  general  health  vary  considerably,  and  one  of  the 
most  important  distinctions  is  to  be  made  between  the  cases 
where  menstruation  was  painful  from  the  beginning,-  and 
those  in  which  the  habit  of  pain  was  only  acquired  later  in 
life.  Among  the  one  hundred  and  seventy  persons,  men- 
struation had  been  more  or  less  painful,  scanty  or  excessive 
from  the  beginning  in  90,  or  53  per  cent ;  while  in  80',  or  46  per 
cent,  no  inconvenience  was  experienced,  until  some  time  after 
its  establishment.  We  will  call  these  two  classes  of  cases. 
Groups  II  and  IV.1  In  Group  II,  three  persons  are  said  to  have 
suffered  exclusively  during  the  first  two  years  of  menstruation, 
which  coincided  with  school  life,  while  others  continued  to  do 
so  up  to  date.  In  one  of  these,  (No  177)  the  pain  is  said  to 
have  been  "  dreadful "  and  spasmodic,  before  marriage,  and 

1  Group  I  being  the  class  without  pain.     Group  III  includes  those  who  suf- 
fered from  the  beginning,  but  slightly. 


40 


'HE   QUESTION   OF   REST    FOR  WOMEN. 


not  to  have  existed  since.  In  three  of  the  remaining  cases,  the 
patients  suffered,  not  from  pain,  but  from  amenorrhea  (cases 
1 1 6,  127,  143).  The  history  of  each  of  these  is  interesting,  and 
will  be  analyzed  later.  In  sixteen  cases  the  pain  at  menstru- 
ation was  so  slight,  that  practically  the  patients  might  have 
been  ranked  in  the  class  of  painless  cases.  Finally  seventy 
persons  suffered  from  pain  decided  or  severe,  in  some  cases 
very  severe,  or  else,  instead  of  pain,  were  prostrated  by  ex- 
cessive flowing.  These  latter,  however,  were  in  the  minority, 
only  six.  Two  of  these  (130  and  146)  suffered  from  severe 
dysmenorrhea  during  the  first  six  or  seven  years  of  menstrual 
life,  but  later  the  pain  was  replaced  by  menorrhagia.  The 
interpretation  of  such  cases  is  of  much  importance.  These 
general  results  may  be  thus  tabulated. 

TABLE   IX.     (GROUPS  2  AND  3.) 


64 


rhagia.  jAmenorrhea.  Per  cent,  of  preceding. jSlight  pain.!    Per  cent. 


So  per  cent. 


[9  per  cent. 


Among  the  seventy-three  cases  of  those  who  suffered 
severely  from  pain,  menorrhagia,  or  amenorrhea,  forty-three, 
or  58  per  cent.,  exercised  while  at  school  two  hours  and 
under  a  day,  frequently  not  more  than  one,  while  twenty-one, 
or  28  per  cent.,  exercised  three  hours  and  over.  Nine  cases 
are  not  specified.  Among  the  eighteen  who  suffered  but 
slightly,  eleven,  or  61  per  cent.,  exercised  two  hours  and 
under,  and  seven,  or  37^-  per  cent.,  exercised  three  hours  and 
over. 

TABLE   X.— EXERCISE   IN   SCHOOL   LIFE.     (GROUTS  2  AND  3.) 


Two  hours  or  under. 

Three  hours  or  over. 

Severe  pain  .  .  . 
Slight  pain 

58  per  cent. 
61  per  cent. 

28  per  cent.  (30  per  cent  of  whole). 
37^  per  cent. 

ANALYSIS   OF  TABLE   X.  4! 

The  proportions  do  not  vary  enough  to  largely  explain 
the  comparative  immunity  of  the  second  division  by  a  greater 
attention  to  exercise  during  school  life,  yet  the  balance,  such 
as  it  is,  is  in  favor  of  this  influence,  since  in  this  division  37^ 
per  cent,  obtained  abundant  exercise,  while  this  was  the  case 
with  only  32  per  cent,  of  the  first  division.  Individual  cases 
are  not  always  in  accordance  with  this  general  average,  how- 
ever. Thus  case  85  was  accustomed  to  only  one  and  a  half 
hours  exercise,  yet  suffered  little  pain,  while  No.  54  exer- 
cised five  to  six  hours,  yet  suffered  severe  menstrual  pain 
until  the  birth  of  first  child.1  Nevertheless,  from  the  general 
average,  we  are  warranted  in  concluding  that  insufficient 
exercise  during  school  life  may  be  one  factor  in  the  produc- 
tion of  severely  painful  menstruation,  since  among  those  who 
suffered  severely,  a  smaller  proportion  of  girls  exercised  suf- 
ficiently than  among  those  who  experienced  only  slight  dis- 
comfort. 

Upon  comparing  these  results  with  those  obtained  from 
the  first  series  of  ninety  cases,  in  which  menstruation  oc- 
casioned no  pain  or  inconvenience,  we  find  that  the  pro- 
portion of  exercise  was  in  them  greater  than  among  the 
cases  of  the  second  series.  This  has  been  shown,  page  30. 
The  proportion  of  those  who  exercised  over  two  hours  was 
57|  per  cent.,  and  under,  42!  per  cent.  If  we  add  together 
the  numbers  of  those  who  suffered  very  slightly  and  those 
who  did  not  suffer  at  all,  we  have  a  total  of  one  hundred  and 
eight,  of  whom  sixty-five,  or  60  per  cent.,  took  sufficient 
exercise,  while  thirty-nine,  or  36  per  cent.,  exercised  very 
little.  The  difference  between  the  two  is  24  per  cent,  while 
the  difference  between  the  two  divisions  of  those  who  suf- 
fered severe  pain  is  30  per  cent. 

1  This  patient  was  treated  for  subinvolution,  but  reports  herself  cured.  As 
the  larger  number  of  very  severe  dysmenorrheas  of  early  adolescence  are  asso- 
ciated with  a  narrow  os  uteri,  and  this  is  an  index  of  general  lack  of  development 
of  the  organ,  there  is  an  indication  of  deficient  nutritive  force  in  the  generative 
organs  that  might  be  expected  to  favor  subinvolution. 


42  THE    QUESTION    OF    REST    FOR    WOMEN. 

The  family  history  of  girls  who  began  to  suffer  pain  with 
their  first  menstruation  is  most  important.  Among  sixty- 
seven  persons  suffering  from  severe  pain,  or  else  from  amen- 
orrhea,  the  family  health  is  said  to  have  been  good  in  twenty- 
six,  or  38-5  per  cent.,  and  poor  in  forty-one,  or  61  per  cent. 
Among  the  twenty-six  cases,  twenty-one  are  reported  simply 
as  good,  one  as  very  good,  one  as  perfectly  good,  one  as  per- 
fect, one  as  excellent,  one  as  unsurpassed.  The  family  his- 
tory of  the  forty-one  other  cases  deserves  to  be  tabulated. 


TABLE    XI.     FAMILY    HEALTH.     (GROUP    II.) 


Good. 

26,  or  38-!  per  cent. 

Poor. 

41,  or  61-3-  per  cent. 

17 

Scrofula. 

24 

Poor. 

26 

Scrofula. 

28 

Childhood  delicate. 

10 

Mother  consumptive. 

36 

"        uterine  disease. 

39 

cancer. 

42 

Father  consumptive. 

51 

Childhood  delicate. 

54 

Parents 

61 

Consumptive. 

74 

Father  rheumatic. 

78 

Gout  rheumatism. 

75 

" 

81 

Childhood  sickly. 

84 

Parents  consumptive. 

93 

99 

Poor. 

100 

Consumption. 

IOI 

" 

III 

Sister  tuberculous,  subinvolved  uterus. 

112 

severely  epileptic. 

TABLES   XI-XII. 


43 


"5 

Mother  menorrhagic. 

116 

subinvolved  uterus. 

120 

Sister  with  uterine  disease. 

I23 

Mother  "         "            " 

126 

Sisters   " 

I27 

Poor. 

I29 

Gout. 

I30 

Sister  endometritis. 

131 

Family  hysterical. 

134 

Poor. 

140 

Gout. 

144 

Mother  subinvolution. 

I46 

Uterine  disease. 

I48 

Delicate. 

I49 

•' 

150 

u 

153 

u 

159 

Father  consumptive. 

160 

Sister  uterine  disease. 

172 

Poor,  rheumatism. 

Of  the  eighteen  persons  suffering  slight  pain,  in  ten  the 
family  health  was  delicate  or  consumptive,  in  six  only  was 
good,  in  two  was  not  specified.  As  in  the  table  for  exercise  it 
is  well  to  add  together,  for  the  comparison  of  family  health, 
the  group  of  persons  suffering  slight  menstrual  pain  during 
adolescence,  (which  we  will  henceforth  call  Group  III,)  and 
of  those  who  did  not  suffer  at  all  (Group  I).  The  following 
table  represents  the  family  health  of  the  latter  group  : 

TABLE   XII.— FAMILY   HEALTH   OF   GROUP   I. 

Good. 
58  cases,  or  63!  per  cent,    (i  excellent,  2  perfect). 

Poor. 
33>  or  36i  per  cent. 

4  Mother,  cancer. 
2                                Very  delicate. 

5  Chorea  and  hemiplegia  as  child. 


44 


THE   QUESTION   OF   REST    FOR   WOMEN. 


13 
17 
18 

22 
28 
29 

3° 
36 
35 
39 
14 
43 
46 

47 

48 

49 
51 
54 
5° 
53 
60 

67 
68 
70 
76 
80 
81 
82 

85 
88 


Mother  consumptive,  childhood  delicate. 

Not  very  strong. 

Sister  epileptic. 

Father  consumptive. 

Mother  scrofulous. 

Delicate. 

Poor. 

Mother  and  brother  consumptive. 

Sisters  invalids. 

Mother  consumptive. 

Very  poor. 

Not  robust.     Rheumatism. 

Childhood  delicate. 

frail,  mother  consumptive. 
"  "  "        rheumatic. 

Mother  consumptive. 

Delicate  childhood. 

Ec/ema  in  family. 

"  Bilious." 

Uterine  disease. 

Consumptive.     Gout. 

Poor. 

Very  delicate  child. 

Delicate. 

Poor. 

Delicate. 

Poor. 

Father  head  disease,  sister  consumptive. 

Mother  and  sister  delicate. 

Mother  rheumatic. 


We  then  have  : 

TABLE   XII.— FAMILY   HEALTH.     (GROUPS  i  AND  3.) 


58  +  6  =  64,  or  59  per  cent. 
33  4-  10  =  43,  or  40  per  cent. 


Health  of  family  good. 
Health  of  family  poor. 


The  difference  in  the  percentages  of  the  two  groups — that 


TABLE   OF   GENERAL   HEALTH. 


45 


in  whom  family  health  was  good,  and  that  in  whom  it  was 
poor — is  much  lessened  when  the  sixteen  cases  of  "slight 
pain"  are  added  to  the  ninety-one  cases  of  "no  pain."  To 
assist  in  the  interpretation  of  this  fact,  it  is  necessary  to 
examine  the  statistics  of  the  general  health  of  the  cases  in 
the  three  groups  thus  far  analyzed,  namely,  those  who 
(Group  I.)  never  have  suffered  pain  at  menstruation,  those 
who  from  the  first  have  suffered  either  from  severe  pain,  from 
excessive  flowing,  or  from  amenorrhea  (Group  II.),  and  those 
who,  also  from  the  establishment  of  menstruation,  have  only 
experienced  slight  inconvenience  (Group  III.).  The  table  is 
based  on  the  answers  to  the  seventh  question  in  the  circular, 
and  to  the  fourteenth,  the  latter  regarding  the  strength  as 
estimated  by  the  capacity  for  daily  exercise.  Eighty-seven 
cases  are  recorded. 

TABLE   XIV.— GENERAL   HEALTH.     GROUP  i. 


Good. 

Poor. 

70,  or  80  per  cent. 

17,  or  19  per  cent. 

The  details  of  this  table  are  given  below : 

TABLE   GENERAL   HEALTH.    GROUP  WITHOUT  PAIN. 


No.   miles  that 

No.  miles  that 

Nos. 

General  Health. 

can  be  walked 

Nos. 

General  Health. 

can  be  walked 

daily. 

daily. 

18 

Improving     till     24, 

Till  15,  1  mile, 

38 

Good. 

Very  strong. 

then  very  good. 

now  6-8. 

43 

Good. 

Many  miles 

23 

Good. 

3-5- 

39 

Good. 

4-6. 

82 

Sick  headache. 

I  mile. 

I4 

Good. 

12. 

89 

Good. 

Indefinite. 

*9 

Very  good. 

3-4- 

87 
90 

Good. 
Good. 

Long  walks. 
3  miles    an 

10 

27 

Always  good. 
Threatened    with 

10. 

I  mile. 

hour. 

phthisis. 

92 

Good. 

3  miles. 

7 

Very  good. 

4  miles. 

I? 

Good. 

4-10. 

48 

Nearly  perfect. 

10  miles. 

ii 

Excellent. 

10. 

9 

Nearly  perfect. 

5-6- 

55 

jood. 

3-9- 

33 

Sound. 

3-6. 

40 

Perfect. 

8-IO-I2. 

24 

Excellent. 

20. 

46 


THE   QUESTION   OF   REST   FOR   WOMEN. 


X'o.   miles   that 

Xo.   miles   that 

Xos. 

General  Health. 

can  be  walked 
daily 

Xos. 

General  Health. 

can  be  walked 

3 

Generally  good. 

4  till  after  cd 
child. 

4i 

66 

Very  good. 
Congestive      head- 

5-8. 

10. 

aches  at  30. 

2 

Good. 

9  miles. 

67 

Bad.      Severe    dys- 

r. 

22 

Excellent. 

5-6- 

pepsia. 

20 
46 

Generally  good. 
Good. 

4- 

6. 

63 
Si 

Delicate. 
Very  good. 

i. 

6-12. 

So 

(  iood. 

-p 

34 

Good    till  marriage, 

Formerly    6- 

5 

Fair. 

indefinite. 

now  weak. 

10. 

85 

Invalid  from  17  to  25, 

2-3- 

i 

Excellent. 

Strong. 

now  stronger. 

21 

Very  good. 

All  day. 

-.- 

(  ;ood. 

6-7. 

31 

Perfect. 

15  miles. 

52 

Good. 

Longdistance 

26 

Good. 

10  miles. 

56 

(  iood. 

5  miles. 

32 

Not  vigorous. 

1-2  miles. 

29 

Delicate. 

3-4. 

25 

Only  fair. 

i  mile. 

28 

Strom;  in  America. 

pi 

47 

Very  good,  but  neu- 

Not much. 

60 

Had  health. 

No  distance. 

ralgic. 

59 

Verv  fine. 

3  miles. 

73 

Good. 

Not  much. 

58 

Good. 

10. 

46 

Excellent. 

Strong. 

91 
44 

Generally  very  good. 
Always  good. 

3-5- 
5-io-co. 

37 

75 

Perfectly  healthy. 
Sick  headache. 

Strong. 
3  hours. 

8 

Good.       Sick    head 

Strong. 

69 

Good. 

2  miles. 

ache. 

71 

Anemia    after   mar- 

I mile. 

13 

Not  good.  Dyspepsia 

1-2  miles. 

riage. 

12 

Good. 

3  miles. 

-2 

Good. 

5-6. 

16 

Good. 

5-6. 

74 

Good. 

3-4- 

54 

Good,    but    osteitis 

2  miles. 

6 

Perfectly  good. 

5-6. 

once. 

36 

Fair. 

3* 

SS 

Good. 

5-10. 

53 

Hysteria,  anemia. 

r. 

4 

Poor  last  5  years. 

3  miles. 

56 

Anemia. 

2-3- 

20 

(  iood. 

Several. 

57 

Delicate. 

2. 

49 

Good. 

4- 

61 

Robust,  not    accus- 

15 

Excellent. 

5. 

tomed  to  walk. 

5i 

(iood. 

Several. 

62 

Perfectly  good. 

10. 

42 

(iood. 

No  distance. 

63 

Good. 

2. 

35 

Good. 

5  miles. 

64 

Good. 

2. 

52 

Good. 

5  miles. 

65 

Perfect. 

10. 

Out  of  eighty-six  cases  on  this  table,  sixteen  had  deli- 
cate or  poor  health  ;  the  remaining  seventy  report  them- 
selves as  in  health — good,  very  good,  excellent,  or  perfect. 
The  proportions  are  19  per  cent,  and  So  per  cent.  Upon 
comparing  the  specific  cases  on  this  table  with  those  of  Table 
XII.  giving  the  family  health  of  thirty-three  cases  of  this 
Group  I.,  we  find  that  seven  out  of  the  seventeen  cases  of 
poor  health  report  delicate  childhood,  hereditary  consump- 


TABLE  OF  GENERAL  HEALTH.  47 

tion,  delicate  family  health,  and  in  one  case,  uterine  disease 
in  other  members  of  the  family.  The  remaining  ten  cases, 
however,  are  included  among  the  fifty-eight  of  Table  XII., 
in  which  family  health,  and  that  of  childhood,  is  reported  as 
good  or  excellent. 

On  the  other  hand,  out  of  seventy  reported  in  good  health 
and  able  to  walk  from  three  to  twelve  miles,  twenty  are  re- 
corded on  Table  XII  with  a  bad  family  history.  Thus  No. 
49,  is  able  to  walk  nine  miles,  but  the  mother  was  consump- 
tive. No  48  reports  a  frail  childhood,  but  at  present  writing, 
"  nearly  perfect  health "  and  ability  to  walk  ten  or  eleven 
miles.  No.  22,  the  father  was  consumptive,  but  present 
health  is  excellent,  and  ability  to  walk  reaches  five  or  six 
miles,  and  so  on  for  the  other  twenty  cases.  That  is  to  say 
that  in  28  per  cent,  of  the  persons  in  good  health,  and  free 
from  menstrual  pain,  the  health  had  decidedly  improved  since 
childhood  and  adolescence,1  while  in  fifty  cases  or  71  per 
cent,  the  family  health,  and  health  during  childhood  had 
always  been  good. 

The  next  Table  exhibits  the  general  health  of  the  per- 
sons of  the  second  group,  those  namely  who  haye  suffered 
severe  pain  from  the  beginning  of  menstruation. 

TABLE   XV.     GENERAL   HEALTH.     (GROUP  u.) 


Good. 

Poor. 

24,  or  34  per  cent. 

39,  or  56  per  cent. 

The  details  are  given  below : 

1  It  is  assumed  in  this  calculation,  that  the  children  of  consumptive  parents, 
generally  exhibit  some  effects  of  inheritance  under  the  age  of  twenty  or  not 
at  all. 


THE   QUESTION   OF   REST   FOR   WOMEN. 


TABLE   OF   GENERAL   HEALTH   OF   SECOND   GROUP. 


Nos. 

General  Health. 

No.  Miles. 

Nos. 

General  Health. 

No.  Miles. 

j  Q(J 

Good. 

Blank. 

161 

Not  strong. 

Bet.  25  &  32. 

-_ 

5i 

Excellent. 

-5. 

()7 

"     but  neuralgic. 

Little. 

112 

Extremely  nervous. 

2<> 

Not  strong. 

113 

Good. 

84 

\ot  stated. 

4-5- 

U4 

" 

-6. 

39 
1  68 

Not  strong. 
Medium. 

Little. 

15-  (?) 

US 

116 

Anemia. 
Neurotic  amenorrhea 

-5- 

Si 

Not  stated. 

120 

Anemia. 

9 

Fair. 

1-6. 

123 

Good. 

-4- 

175 

Pretty  fair. 

3- 

125 

Anemia. 

-3- 

6 

Constant     improve- 
ment. 

120 
127 

Congestion  uterus. 
Good,  amenorrhea. 

-5- 

57 
130 

Very  good, 
['our. 

Many. 

I29 

78 

Neurotic. 
Delicate. 

5-6. 

132 

Good. 

2. 

46 

Fair. 

Little. 

134 

Neuralgic  anemia. 

2. 

99 

Very  good. 

Much. 

140 

Anemia. 

2( 

IIO 

"         " 

3-4- 

'43 

Good,  amenorrhea. 

ro. 

21 

Good. 

4- 

145 

Very  good. 

6. 

9S 

" 

1-2. 

144 

Fair. 

4- 

III 

Poor. 

1- 

140 

3 

Very  good. 

2-3- 

153 

Anemic. 

3- 

42 

Anemia. 

2. 

154 

Poor     from    uterine 

I. 

17 

Not  strong. 

2. 

disease, 

72 

Good. 

IO. 

156 

Severe  hysteria. 

Blank. 

23 

Poor. 

Very  Little. 

61 

(  "ungest.  uterus. 

5  miles. 

75 

Neuralgic. 

2. 

55 

Good. 

Little. 

26 

Blank.' 

Blank. 

10 

"      backache  last 

IOI 

Very  good. 

5. 

two  years. 

5-6. 

93 

Kidney  disease. 

Little. 

ii 

Good.  ' 

Blank, 

59 

Poor,  Neuralgic. 

1-2. 

§7 

Little. 

4S 

Good. 

10  miles. 

100 

3-20. 

24 

Blank. 

3-4-. 

22 

Blank. 

Blank. 

1  60 

2  miles. 

-5 

i. 

4i 

Excellent. 

3- 

159 

Improving. 

Not  much. 

i/i 

Poor. 

74 

Headache. 

2  bet.  19^  25. 

172 

i. 

36 

Not  strong. 

5- 

Out  of  seventy  cases  (the  three  cases  of  amenorrhea  are 
not  included),  seven  are  blank,  twenty-four,  or  34  per  cent., 
are  in  good  health,  thirty-nine,  or  56  per  cent.,  in  delicate  or 
decidedly  poor  health.  These  proportions  are  in  marked 
contrast  to  those  of  the  first  group,  where  19  per  cent, 
reported  delicate  health,  and  80  per  cent,  good  and  excellent 
health.  The  amount  of  exercise  taken  by  the  persons  of  this 


ANALYSIS   OF   TABLE   OF    HEALTH.  49 

second  group  who  consider  their  health  good,  is  also  inferior 
to  that  of  the  first  group.  Thus,  after  subtracting  from  the 
seventy  women  in  good  health,  of  the  first  group,  ten  who 
report  indefinitely  in  regard  to  their  capacity  for  exercise, 
stating  it  as  many  miles,  "  several  miles,"  "  long  .distance," 
etc.,  we  find  that  the  several  maximum  capacities  of  the 
remaining  sixty  would,  if  added  together,  amount  to  three 
hundred  and  fifty-five  miles.  This  is  an  average  of  about  six 
miles  to  each  person,  while,  as  the  whole  table  shows,  many 
profess  to  be  able  to  walk  ten,  twelve,  or  even  twenty  miles. 
In  the  twenty-four  similar  cases  from  the  second  group,  we 
must  subtract  two  blanks,  two  indefinite,  as  "  many  miles," 
two  as  "  very  little,"  leaving  eighteen  cases.  These  give  a 
sum  total  of  maximum  capacity  of  one  hundred  and  two 
miles,  or  an  average  of  a  little  over  five  miles  to  the  indi- 
vidual. The  difference  is  about  one-sixth  excess  of  exercise 
in  favor  of  those  who  did  not  suffer  pain.  But  in  reality  the 
difference  is  greater,  since  in  the  first  group,  all  who  reported 
indefinitely  in  regard  to  exercise  (10)  speak  of  being  able  to 
walk  a  great  deal,  while  of  the  six  exceptions  in  the  second 
group,  four  walked  only  a  little.  If  we  assume  that  ten 
indefinites  walked  five  miles,  and  the  six  exceptions  two,  the 
difference  between  the  two  groups  would  remain  almost 
exactly  the  same.  Seventy  women  of  the  first  group  would 
then  be  shown  to  walk  four  hundred  and  five  miles,  or  an 
average  of  five  and  five-sevenths,  and  twenty-four  women  of 
the  second  group  to  walk  one  hundred  and  fourteen  miles, 
or  four  and  five-sevenths.  The  difference  is  still  a  mile,  but 
the  proportion  is  a  little  higher  than  one-sixth. 

The  similar  statistics  from  the  eighteen  cases  with  slight 
pain  are  shown  in  the  next  table  : 
4 


THE   QUESTION   OF   REST    FOR   WOMEN. 


TABLE    XVI.— GENERAL    HEALTH    OF    THIRD    GROUP. 


Nos. 

General  Health. 

No.  Miles. 

Xos. 

General  Health. 

No.  Miles. 

91 

Poor  last  2  years. 

3-4- 

71 

Treat,    for     uterine 

85 

Very  good. 

2-3- 

disease. 

2-3- 

56 

Excellent. 

Long  dist. 

88 

Good. 

5  m. 

44 

I  H'spepsia. 

" 

54 

Good    until    child- 

I05 

Good. 

S. 

bearing. 

Very  little. 

64 

Improved. 

6. 

102 

Blank. 

107 
4 

Stronger. 
Very  good. 

S-io. 

58 
32 

Very  fair. 
Good.     Slight    neu- 

3-g. 

96 

Blank. 

3- 

ralgia. 

Several. 

15 

Good. 

6  m. 

I31 

Neurotic. 

2. 

165  jGood. 

Little. 

From  this  table  it  appears  that  twelve,  or  26  per  cent., 
enjoy  good  health,  while  in  six,  or  33  per  cent.,  the  health  is 
broken,  or  at  least  below  par.  The  twelve  persons  in  good 
health  have  a  collective  maximum  capacity  for  exercise  of 
sixty-four  miles,  or  an  average  of  five  and  one-fourth.  In 
this  estimate  we  have  counted  the  report  of  "  Long  distance  " 
as  seven  miles,  "Several,"  three,  "Blank"  as  two,  and 
"  Little  "  as  one.  The  average  is  curiously  similar  to  that 
obtained  from  the  group  of  persons  who  suffered  no  pain, 
and  in  the  same  proportion  superior  to  the  section  of  the 
second  group,  where,  in  spite  of  painful  menstruation,  the 
general  health  was  said  to  be  good. 

To  show  the  constancy  of  these  proportions  we  have 
made  still  another  calculation  from  the  exercise  capacity 
tables  of  the  second  and  third  groups,  in  which  the  persons 
in  good  health  and  poor  health,  /'.  c.  all  the  cases  on  the 
table,  are  taken  together.  The  B.  "  Blank  "  is  estimated  at 
two  miles,  "  Little"  at  one  mile,  and  "many"  at  five.  In 
the  group  second  then,  seventy  persons  walk  collectively  two 
hundred  and  twenty-eight  miles,  an  average  of  three  and 
one-fourth,  while  in  group  third,  eighteen  persons  walk 
eighty-two  miles,  an  average  of  four  and  five-ninths.  Group 


TABLE   OF   EXERCISE.  5  I 

I.,  estimated  in  the  same  manner,  gives  four  hundred  and 
thirty-five  miles  for  eighty-seven  persons ;  or  an  average  of 
exactly  five  miles.  These  results  may  be  compared  better  in 
a  single  table  bringing  them  together  : 

TABLE   XVII.— MAXIMUM   CAPACITY   FOR   EXERCISE. 


Group  i.    No  Pain. 

Group  3.    Severe  Pain. 

Group  3.    Slight  Pain. 

Average  of  entire  group  : 
435  miles,  or  5  a  piece. 

Average   healthy  section  : 
405  miles,  or  sf  a  piece. 

Average  of  entire  group  : 
228  miles,  or  3^  a  piece. 

Average   healthy  section  : 
114  miles,  or  4f-  a  piece. 

Average  of  entire  group  : 
82  miles,  or  4f  a  piece. 

Average   healthy   section: 
64  miles,  or  5  J  a  piece. 

Before  tabulating  the  statistics  of  occupations  and  of 
periodical  rest  of  Groups  2  and  3,  it  is  desirable  to  analyze 
the  fourth  group — of  persons  namely  who  began  to  suffer 
pain  or  other  inconvenience  during  menstruation  only  at« 
some  period  after  its  establishment.  These  cases  have  been 
separated  from  the  rest,  in  order  to  distinguish  between  the 
influence  of  hereditary  constitutions  or  congenital  conditions, 
and  that  of  modes  of  life,  since  the  first  would  be  expected 
to  be  felt,  if  at  all,  during  adolescence ;  the  second  would 
only  make  itself  apparent  later,  and  should  deepen  with  the 
persistence  of  its  cause. 

There  are  seventy-one  cases  in  this  category,  or  Group  4.' 
Of  these,  forty-three,  or  60  per  cent.,  suffered  severely,  while 
twenty-eight,  or  39  per  cent.,  only  suffered  occasionally  or 
slightly. 

These  proportions  differ  considerably  from  those  of  the 
class  in  whom  menstrual  disturbance  existed  from  the  first 
(see  Table  IX.).  The  result  may  be  contrasted  in  a  single 
table  : 

1  The  remaining  nine  cases  (see  page  z6)  have  not  given  sufficiently  detailed 
histories. 


THE   QUESTION*   OF   REST   FOR   WOMEN. 


TABLE   XVIII. 


Pain,  etc.,  from  first  menstruation. 

Pain,  etc.,  subsequent  to  first. 

Severe. 

Slight. 

Severe. 

Slight. 

80  per  cent. 

19  per  cent. 

60  per  cent. 

39  per  cent. 

The  statistics  in  regard  to  school  attendance  of  this 
group  have  already  been  considered  in  contrasting  the  whole 
of  the  second  class  with  the  whole  of  the  first. 

It  is  desirable,  however,  to  contrast  the  different  schemes 
of  education  in  the  two  divisions  of  the  second  class  : 

TABLE    XIX. 


Pain,  etc.,  from  th,e  first. 
Education. 


Pain,  etc.,  subsequently. 
Education. 


Common  Ed. 

Ornamental. 

Higher. 

Common  Ed. 

Ornamental. 

Higher. 

28,  or  3i|- 
per  cent. 

21,01-23 
per  cent. 

40,  or  44/5 
per  cent. 

16,  or  22 
per  cent. 

26,  or  36 
per  cent. 

30,  or  41 
per  cent. 

The  proportion  in  the  two  classes  of  persons  who  have 
only  received  a  common  English  education,  is  12  per  cent,  in 
favor  of  the  first  section.  In  ornamental  education  there  is 
a  difference  of  13  per  cent,  in  favor  of  the  second  section; 
and  in  the  higher  education,  nearly  4  per  cent,  in  favor  of 
the  first  again.  Thus  those  who  had  the  least  education 
were  not  thereby  prevented  from  being  the  most  precocious 
in  menstrual  suffering  ;  and  on  the  other  hand,  those  in  whom 
education  was  the  most  prolonged  were  not  predominantly 
they  in  whom  pain  began  a  few  years  after  the  establishment 
of  menstruation,  i.  c.  at  the  epoch  when  the  average  course 
of  study  was  being  extended. 

Finally  the  greatest  difference  obtains  in  regard  to  the 


TABLE   OF   EXERCISE.  53 

ornamental  section  which  furnishes  a  much  larger  proportion 
of  persons  whose  menstruation  becomes  deranged  after  the 
usual  period  of  school  life  is  over. 

The  next  table  shows  the  statistics  of  exercise  taken  while 
in  school.     The  calculation  excludes  the  third  column. 

TABLE  XX.    EXERCISE.     (GROUP  4.) 


Under  Three  Hours. 

Three  Hours  and  over. 

Not  stated. 

41,  or  62  percent. 

25,  or  29  per  cent. 

6,  or  8J  per  cent. 

This  table  has  been  based  on  the  calculation  that  any  de- 
gree of  exercise  less  than  three  hours,  is  insufficient  for  a 
growing  school  girl,  and  the  very  large  proportion  of  cases 
from  this  group,  when  only  this  amount  was  taken,  shows 
the  influence  the  poor  regime  exercises  upon  the  after  life. 
It  very  closely  resembles  the  per  centage  table  fn  Groups  II 
and  III,  when  the  pain  was  experienced  from  the  first, 
(Table  X),  and  also  Table  i£  of  the  painless  cases.  Never- 
theless there  is  3  per  cent,  insufficient  exercise  cases  in  favor 
of  the  Table  of  suffering  persons,  the  per  centages  of  really 
sufficient  exercise  being  almost  identical,  while  compared 
with  the  Table  of  those  who  suffered  from  the  first,  excess  of 
insufficiency  is  4  per  cent,  and  excess  of  sufficiency  in  the 
former  table,  I  per  cent.  It  would  follow  that  insufficient 
exercise  during  school  life,  exerted  somewhat  more  influence 
upon  the  menstruation  after  the  school  epoch  was  completed 
than  at  the  time. 

The  next  table  exhibits  the  family  history  of  Group  IV, 
compared  with  the  preceding.  The  health  is  said  to  have 
been  good  in  twenty-seven  cases  of  the  seventy  in  which  it  is 
recorded,  or  39  per  cent.,  and  poor  in  forty-three,  or  61  per 

1  The  percentage  in  table  will  be  found  to  be  the  same,  if  calculated  on  the 
whole  number,  as  in  the  two  groups,  the  second  per  centage  is  30. 


54 


THE   QUESTION   OF   REST   FOR   WOMEN. 


cent.     These  proportions  much  resemble  those  of  the  Group 
II,  (severe  pain.) 

TABLE    XXI    OF    FAMILY    HEALTH  OF    FOUR   GROUPS. 


Group  i. 

Group  2. 

Group  3. 

Group  4. 

Good. 

58  or  632 
per  cent. 

33  or  36J 
per  cent. 

Good. 

26  or  38  1 
per  cent. 

Good. 

6  or  3;J 
per  cent. 

Good. 

27  or  38 
per  cent. 

Poor. 

Poor. 

41  or6i| 
per  cent. 

Poor. 

10  or  62  \ 
per  cent. 

Poor. 

43  or  61 
per  cent. 

Indeed  a  glance  at  the  above  table  shows  that  the  con- 
dition of  family  health,  or  health  during  childhood,  was  ex- 
ceedingly alike  in  all  three  of  the  Groups  representing  pain, 
while  in  Group  I  or  the  painless  Group,  the  proportions  of 
good  health  to  bad  are  exactly  reversed.  There  is  even  a 
larger  proportion  of  good  hereditary  antecedents  in  this 
Group,  than  there  is  of  poor  in  the  others.  Specifications  of 
poor  health  are  about  the  same  as  in  the  other  tables. 

The  occupations  of  Group  IV  are  of  much  importance  to 
consider. 

TABLE   XXII.     OCCUPATIONS.     (GROUP  4.) 


Social. 

Married. 

Teaching. 

Miscellaneous. 

\rt                              3 

Medicine  7 
Servant  
Missionary  

23,  or  simper  cent. 

9,  or  ii  per  cent. 

17,  or  22  per  cent. 

Clerk  
Photographs  .... 
Matron  
Literary    
Sister  Charity.  .  . 

22,  or  30  per  cent. 

It  is  most  important  to  contrast  the  Table  of  Occupations 
of  Group  4,  with  that  of  Group  I.  For  convenience,  their 
contrast  may  be  shown  in  a  single  table. 


OCCUPATIONS   AND   MENSTRUATION. 


55 


TABLE   XXIII. 


Social,  /'.  e.  unmarried 
and  unemployed. 

Married. 

Teaching. 

Miscellaneous. 

I. 
IV. 

8  per  cent. 

I. 

25  per  cent. 

I. 
IV. 

2g|  per  cent. 

I. 

20  per  cent. 

31}^  per  cent. 

IV. 

II  per  cent. 

22  per  cent. 

IV. 

30  per  cent. 

The  term  "  Social  "  on  the  table  is  used  to  include  all  un- 
married women  without  special  paid  employment.  On  many 
of  the  circulars  such  persons  record  themselves  as  engaged 
in  housework,  on  others  as  having  no  "  occupation,"  or  being 
young  ladies  "  of  leisure."  Of  the  married  women  of  Group 
I,  twenty-one  bore  several  children,  and  thus  could  be  said  to 
have  a  special  employment. 

The  contrast  between  the  number  of  married  women  in 
the  two  groups  is  most  remarkable.  While  among  those  who 
never  suffer  pain  at  menstruation,  25  per  cent,  are  married, 
from  the  group  that  some  time  after  the  establishment  of 
menstruation  began  to  suffer  pain,  only  n  per  cent,  are  mar- 
ried. Again  only  8  per  cent,  of  the  painless  group  are  recorded 
as  without  special  occupations,  while  nearly  32  per  cent,  are 
so  recorded  in  the  second  division. 

This  proportion  is  higher  than  that  of  persons  engaged  in 
Teaching  or  Miscellaneous  occupations.  There  is  a  larger 
proportion  of  teachers  in  the  painless  than  in  the  painful 
group,  but  the  proportion  of  Miscellaneous  occupations  is 
larger  in  the  latter.  It  happens,  however,  that  the  actual 
numbers  of  the  most  intellectual  and  the  most  mechanical 
occupation  among  these,  are  almost  identical  in  the  two 
groups.  In  the  first  group  are  eight  cases  for  medical,  and 
four  for  factory  work.  In  the  fourth  group,  seven  for  medi- 
cine, and  equally  four  for  the  factory. 

So  far  as  any  inferences  can  be  drawn  from  these  figures, 


56  THE   QUESTION   OF   REST    FOR   WOMEN. 

we  may  conclude  that  adult  \vomen  who  are  married  es- 
cape danger  of  menstrual  disturbance  in  the  proportion  of 
14  per  cent.,  (25-11)  and  that  those  who  are  unmarried 
and  without  occupation,  incur  this  danger  in  the  proportion 
of  24  per  cent.  (32-8.)  Finally  that  among  the  small  num- 
bers of  occupations  examined,  teaching  would  seem  to  be  the 
least  liable  to  be  followed  by  disturbance  of  menstrual  health. 
This  last  conclusion,  however,  cannot  be  relied  upon,  since 
the  proportion  of  no  other  occupation  given  is  large  enough 
to  be  compared  with  teaching. 

The  significance  of  a  table  of  occupations  of  Groups  II  and 

III  is  rather  to  demonstrate  the  extent  to  which  women  may 
continue  work,  even   though  partially  crippled  by  menstrual 
suffering,   than    to    show    how  this  could    be  influenced  by 
their  work,  since  it  existed  before  any  occupation  was  taken 
up.     It  has  been  omitted. 

It  is  now  necessary  to  ascertain  what  proportion  of  Group 

IV  retained  fair  general  health  and  capacity  for  exercise,  even 
though  acquiring  the  habit  of  menstrual  pain. 

Among  the  seventy-two  persons  in  Group  IV,  thirty,  or 
4i|-  per  cent,  had  been  treated  for  some  form  of  uterine  dis- 
ease, while  forty-two,  or  58^  per  cent,  had  never  been  so 
treated,  thirty-two,  or  44^  per  cent,  were  in  good  general 
health,  while  forty,  or  55^  per  cent,  were  in  poor  health.  Of 
the  thirty-two  persons  in  good  general  health,  only  five  are 
said  to  have  had  severe  pain,  in  eight  cases  the  degree  is  not 
specified,  and  in  nineteen,  it  is  said  to  have  been  slight  or 
occasional.  In  the  great  majority  of  the  cases  therefore,  when 
the  habit  of  menstrual  suffering  was  acquired,  it  coincided 
with  a  breaking  down  of  the  general  health. 

In  regard  to  the  maximum  capacity  for  exercise,  calcu- 
lated as  for  the  preceding  groups,  (see  Table  XVII),  it  is 
found  that  the  seventy-two  persons  collectively  could  walk 
two  hundred  and  eighty-eight  miles,  or  exactly  four  a-piece. 
This  is  less  than  for  any  group,  except  that  of  severe  primary 


REST   AT  MENSTRUAL  PERIOD.  57 

pain.  The  thirty-two  persons  in  good  health  walked  one 
hundred  and  eighty-two  miles,  or  five  and  eleven-twelfths 
a-piece,  while  the  forty  persons  in  poor  health  walked  one 
hundred  and  six  miles,  or  two  and  nine-tenths  a  piece.  This 
last  is  very  much  the  smallest  on  any  table,  while  the  aver- 
age of  the  healthy  section,  as  seen,  does  not  differ  materially 
from  that  of  the  groups  who  suffered  no  pain,  especially  of 
the  healthy  section  of  that  group.  Unless,  therefore,  the 
habit  of  menstrual  pain  resulted  from  or  was  associated  with 
deterioration  of  general  health,  it  did  not  affect  the  strength 
or  capacity  for  exercise,  nor  presumably  of  work. 

The  final  inquiry  refers  to  the  amount  of  rest  observed 
during  the  menstrual  period  by  the  persons  of  Group  IV. 
Forty-two  persons,  or  58-^  per  cent.,  habitually  required  rest, 
during  from  one-half  day  (one  case)  to  one  week.  In  all  the 
cases  but  two,  this  rest  was  taken.  In  thirty  cases,  or  41$ 
per  cent.,  no  rest  was  indulged  in,  except  occasionally,  and 
in  only  two  of  these  cases  was  it  considered  desirable. 

Of  Groups  II.  and  III.  of  ninety-one  cases,  forty-six  re- 
quired rest ;  and  all  but  five  of  them  rested,  from  a  few  hours 
to  several  days.  This  is  50^  per  cent.  Forty-four,  or  48^ 
per  cent.,  required  no  rest.  Of  course  in  this  number  are 
included  the  sixteen  cases  of  very  slight  pain,  and  the  three 
cases  of  amenorrhea,  leaving,  however,  twenty-five  cases  of 
dysmenorrhea  or  menorrhagia,  when,  notwithstanding  the 
suffering,  no  rest  was  claimed. 

The  statistics  of  rest  for  the  four  groups  may  be  con- 
veniently contrasted  in  the  following  table  : 

TABLE   XXIV.— OF   REST. 


Group  I. 

Groups  II.  and  III. 

Group  IV. 

Rest  .  .  . 
No  rest. 

9,  or  ii  per  cent. 
80,  or  88  per  cent. 

46,  or  so|  per  cent. 
44,  or  48^  per  cent. 

42,  or  $8£  per  cent. 
30,  or  4i|  per  cent. 

58  THE   QUESTION   OF   REST   FOR   WOMEN. 

It  is  unfortunately  difficult  from  these  tables  to  infer  to 
what  extent  the  neglect  of  rest  could  be  blamed  for  the  habit 
of  menstrual  pain  gradually  developed,  since  in  no  instance 
does  rest  seem  to  have  been  observed  until  or  unless  pain,  or 
weakness  from  excessive  flo\v  were  present  ;  and  the  habit 
was  stopped  as  soon  as,  by  the  cure  of  uterine  disease,  or  by 
improvement  of  the  general  health,  menstrual  discomfort 
abated.  It  is  worth  noting  as  a  net  result,  that  of  twro  hun- 
dred and  fifty-two  women  where  the  detail  is  stated,  ninety- 
seven,  or  38  per  cent.,  were  in  the  habit  of  resting  more  or 
less  during  menstruation,  while  one  hundred  and  fifty-five, 
or  61  per  cent.,  took  no  rest  at  all. 

We  will  now  summarize  the  results  obtained  from  the 
analysis  of  two  hundred  and  sixty-eight  cases,  whose  histories 
enter  more  or  less  completely  into  the  foregoing  series  of 
tables. 

i.  Out  of  this  number  of  women  interrogated  at  hazard, 
ninety-four,  or  35  per  cent.,  declare  themselves  to  have  been 
always  completely  free  from  discomfort  during  menstruation. 
Moreover,  if  we  add  to  this  number  the  eighteen  from  Table 
IX,  and  twenty-eight  from  Group  IV  on  page  57,  who  only  suf- 
fered slightly  or  occasionally,  we  have  a  total  of  one  hundred 
and  forty,  or  59  per  cent,  of  cases  where  menstruation,  so  far  as 
the  consciousness  of  the  women  went,  could  not  be  considered 
of  sufficient  moment  to  interrupt  daily  avocations.  It  is  to  be 
remembered  that  from  these  statistics  are  carefully  excluded 
those  cases  where  the  women,  though  suffering  slight  pain, 
are  more  dangerously  prostrated  by  excessive  hemorrhage. 

If  our  statistics  be  combined  with  those  of  Brierre  de 
Boismont  given  on  page  26,  we  shall  have  a  total  of  (268  + 
360)  six  hundred  and  t\venty-eight  women.  Of  these  (94  +  82) 
one  hundred  and  seventy-six  were  completely  free  from  pain, 
(28  per  cent.),  while  (154  +  278)  four  hundred  and  thirty-two, 
or  68f  per  cent.,  suffered  to  a  greater  or  less  extent.  As 
Brierre  de  Boismont,  however,  does  not  distinguish  between 


GENERAL   ANALYSIS.  "59 

the  trifling  colic,  to  which  scarcely  any  attention  is  paid,  and 
the  severe  dysmenorrhea,  which  temporarily  prostrates  the 
unfortunate  victim,  his  statistics  are,  for  practical  purposes, 
much  less  valuable  than  ours,  and  the  last  combination  of 
them  with  ours  of  much  less  significance  than  the  first. 

There  remain,  however,  on  our  own  statistics,  one  hun- 
dred and  twenty-eight  cases,  or  47  per  cent.,  of  women  to 
whom  menstruation  was  a  seriously  painful,  therefore  morbid 
process.  It  may  be  at  once  asserted  that  in  all  such  cases 
rest,  during  the  existence  of  such  pain,  is  as  desirable  as 
during  the  occurrence  of  any  other. 

2.  Of  the  one  hundred  and  sixty-two  painful  cases,  i.  e. 
including  all  degrees  of  pain,  53  per  cent,  had  been  so  from 
the  beginning;  in  46  per  cent,  the  habit  had  been  acquired. 
The  importance  of  this  distinction  will  appear  when  we  dis- 
cuss in  detail  the  causes  of  menstrual  pain.     It  is  evident  at 
the  outset,  that  wherever  pain  had  existed  from  the  age  of 
thirteen    or  fourteen,   no    unremitting   occupation,   adopted 
eight  or  ten  years  later,  could  be  held  to  be  the  cause  of  it. 
The  only  occupation  to  be  considered  in  this  connection  is 
that  of  study  at  school. 

3.  The  number  of  hours  spent  in  study  while  at  school, 
the  studies  pursued,  and  the  number  of  years   occupied  by 
education,  are  all  a  good  deal  alike  throughout  our  entire 
series  of  cases.     Nevertheless,  it  has  been  shown  (a)  that 
1 8  per  cent,  of  the   second   class  (pain)  received  very  little 
education,   while   none    are    so    specified    in    the    first   class. 
(fr)  The  average  for  beginning  school  attendance  is  younger 
in  the  second  class  than  in  the  first  (see  page  37).     The  most 
frequent  age  in  both  classes  is  from  five  to  eight ;  but  in  the 
second  class  (pain)  21  per  cent,  of  these  begin  under  five, 
while  in  the  first  class  it  is  13  per  cent,     (c}  The  average  of 
leaving  is  also  nearly  the  same,  and,  from   the  tables,  no 
reliable  conclusions  can  be  drawn  in  regard  to  this  point. 
The  proportion  of  persons  who  pursued  advanced  studies 


60  THE  QUESTION   OF    REST    FOR    WOMEN. 

beyond  the  age  of  twenty-two,  was  1 6  per  cent,  in  the  first 
class  ('painless),  only  8^  in  the  second,  as  observed  on  page 
37.  The  educational  coincidences  of  menstrual  pain  are 
therefore  with  more  prolonged  primary  and  secondary  educa- 
tion, but  seem  to  have  no  connection  with  higher  studies. 
((/')  Combining  the  results  of  Table  II.,  page  31,  and  Table 
XIX.,  page  52,  we  find  that  among  those  specified  from  the 
painless  group  (76  out  of  94)  the  proportions  of  common, 
ornamental,  and  higher  systems  of  education  are  respectively 
26^,  1 8^,  55-3  per  cent.,  while  among  the  persons  who  suffered 
pain  it  is  27,  29,  and  43  per  cent.  These  figures  show  that 
the  larger  proportion  of  our  statistics  have  been  taken 
('accidentally)  from  among  persons  comparatively  highly  edu- 
cated. The  highest  education  (at  present  given  to  women) 
is,  according  to  these  proportions,  much  the  most  favorable 
to  menstrual  health  ;  the  least  favorable  is  the  ornamental 
system.  This  is  generally  received  by  a  class  that  figure 
apart  on  the  table  of  occupations,  as  having  no  occupation. 

4.  Throughout  our  entire  series  of  cases  the  majority  of 
persons   arc   shown   to   have   had   too   little   exercise  during 
childhood   and   girlhood.     Comparatively  few  have  received 
anything  like  a  systematic  physical  education.     But  the  class 
who   never   suffered   menstrual   pain  exercised   a   great   deal 
more  than  the  other  class.     67  per  cent,  received  a  fair  share 
of  exercise,   while    in   the    second   class,    only  47   per  cent, 
(sec  page  52). 

5.  There  is  a  remarkable  contrast  in  the  family  history  of 
the  persons  who  never  suffered  pain,  and  of  those  who  did  ; 
and  the  percentage  of  good  health  and  bad  is  almost  identical 
in  those  who  suffered  pain  from  the  beginning,  and  in  those 
in  whom  the  painful  habit  was  acquired.     By  combining  the 
columns  for  Groups  II.  and  III.  in  Table  XXI.,  we  have  for 
persons  who  never  suffered  pain,  good  family  history  in  63! 
per  cent.,  while  in  those  who  suffered  from  the  beginning  it 
was   38,  and   in   those  who   acquired   suffering,  also   38   per 


ANALYSIS   OF   TABLES,    HEALTH   AND   OCCUPATION.      6 1 

cent.  The  percentages  of  poor  health  are  respectively  36^, 
61,  and  62^  per  cent.  These  figures  show  conclusively  that 
a  large  proportion,  two-thirds,  of  persons  suffering  at  men- 
struation, inherit  some  defect  either  of  general  constitution, 
or  of  special  tendency  to  uterine  disease,  or  else  have  passed 
a  delicate  childhood  ;  while  on  the  other  hand,  the  very  same 
proportion,  two-thirds,  of  persons  healthy  in  regard  to  men- 
struation, had  passed  a  vigorous  childhood  and  inherited 
strong  constitutions.1  These  facts  are  all  to  be  considered  in 
estimating  the  degree  to  which  pain  at  menstruation  is  to  be 
regarded  as  a  normal  character,  inherent  in  a  physiological 
process. 

6.  Similar  inferences   are   to  be  drawn  from   the  tables 
showing  the  actual  general  health  and  maximum  capacity  for 
exercise  of  persons   comprised  in  the  different  groups.     In 
the  persons  without  pain,  the  average  capacity  for  exercise 
was  five  miles,  while  many  claimed  to  walk  ten  or  fifteen,  a 
few  even  twenty.     Among  the  persons  who  suffered  severe 
pain  from  the   beginning  of  menstruation  the  average  was 
three  and  one-quarter,  of  slight   pain  four  and   five-ninths, 
and  of  acquired  pain,  four  miles.     Capacity  for  exercise  was 
nearly  always  in  inverse  proportion  to  the  habit  of  pain. 

7.  From  the  tables  of  occupation  the  principal  fact  to  be 
deduced  was,  that   persons  without   occupation   suffered  at 
menstruation  in  a  much  larger  proportion  than  those  who 
were  occupied.     On  Table  XXIII.  only  two  groups  are  con- 
trasted, those  who   never  suffered,  and  those  who  acquired 
the  habit  (see  page  55).     It  has  been  noticed  above,  that 
the  persons  classed  under  the  head  of  "social"  or  house- 
keeping  occupations,   are    largely  those   who    received    the 
"  ornamental  "  education.     They  are  also  all  unmarried. 

1  Further  that  in  those  whose  menstrual  health  breaks  down  after  several 
years,  family  history  seems  to  be  accountable  to  precisely  the  same  extent  as  in 
those  who  suffer  from  the  beginning.  This  circumstance  is  of  great  importance 
in  estimating  the  influence  of  occupations  that  are  the  apparent  cause  of  the 
breakdown. 


62  THE    QUESTION    OF    REST    FOR    WOMEN. 

S.  Marriage  finally  (sec  page  55)  is  much  more  opposed 
than  celibacy  to  the  persistence  of  menstrual  pain  in  adult 
life.  From  accidental  circumstances,  the  number  of  celibates 
is  larger  in  our  series  than  the  number  of  married  women. 
Were  it  not  so,  we  should,  as  it  appears,  have  reason  to  find 
a  much  larger  proportion  of  women  free  from  menstrual  pain.1 

Rest  during  menstruation  cannot  be  shown,  from  our 
present  statistics,  to  exert  any  influence  in  preventing  pain, 
since,  when  no  pain  existed,  it  was  rarely  taken  (see  page 
57,  Table  XXIV.). 

In  Group  IV.,  where  pain  had  been  acquired,  the  habit 
of  resting  was  acquired  in  man}-  cases  with  it  (58^  per  cent.), 
but  not  in  all.  It  is  precisely  in  regard  to  this  group  that 
the  question  is  pertinent,  whether  a  habit  of  resting,  adopted 
early  in  life,  might  have  prevented  the  development  of  suffer- 
ing; but  from  the  table  itself,  we  can  obtain  no  answer  to 
this  question. 

Judging  by  these  statistics  alone,  therefore,  we  should 
say,  that  immunity  from  menstrual  suffering  was  to  be  ex- 
pected in  proportion  to:  I.  The  vigor  of  health  during  child- 
hood, and  the  soundness  of  family  history,  especially  in  regard 
to  freedom  from  constitutional  taint  of  scrofula,  consump- 
tion, or  rheumatism,  or  family  tendency  to  uterine  disease. 

2.  To  the  degree  of  exercise  taken  during  school  life. 

3.  To    the    thoroughness    and    extension   of  the    mental 
education. 

4.  To   the  degree  to  which  general  health,  and   capacity 
for  exercise,  was  maintained  after  cessation  of  study. 

5.  To  steadiness  of  occupation. 

6.  Finally,  to  marriage  at  a  suitable  time. 

As  regards  rest — the  most  important  question  for  our 
purpose— we  have  seen  that  the  above  data  do  not  suffice  to 

1  We  do  not  of  course  mean  to  deny  that  marriage,  by  means  of  childbearing; 
often  becomes  the  starting  point  of  uterine  disease,  but  even  this  is  not  always 
accompanied  by  dysmenorrhea. 


QUESTIONS.  63 

inform  us  of  its  influence.  We  can  only  assert  negatively, 
that  in  a  large  proportion  of  cases  it  has  been  quite  super- 
fluous. 

Several  questions  are  suggested  by  this  summary. 

1.  Why  does   menstrual  pain  exist  from  the  first  men- 
struation in  some  cases,  and  not  until  long  after  in  others, 
and  what  is  the  true  cause  of  it  in  each  class  of  cases  ? 

2.  Why  is  it  that  a  large  number  of  persons,  though  the 
minority,  suffer  menstrual  pain,  though  otherwise  in  good 
health,  while  conversely,  many  others  (also  the  minority), 
though   in   delicate   or   even    feeble   health,    experience   no 
special  discomfort  at  the  menstrual  epoch  ? 

3.  Why  should  pain  ever  be  experienced  during  the  men- 
strual flow,  any  more  than  during  an  epistaxis,  or  any  other 
natural  evacuation?     If  menstruation  be  a  physiological  pro- 
cess, for  which  due  provision  has  been  made  in  the  economy, 
why  should  it,  in  46  per  cent,  of  cases  of  persons  in  civilized 
classes  of  society,  create  disturbance  ? 

4.  Is   there    anything   peculiarly  threatening  about   this 
disturbance  when  it  exists,  so  that  such  resolute  effort  to  dis- 
regard it  as  is  frequently  considered  desirable  for  other  pain 
--headache,  neuralgia — should    be  strenuously  discouraged, 
as  liable  to  lead  to  a  still  greater  evil? 

5.  Finally,  is  there  anything  in  the  nature  of  menstrua- 
tion that  should  lead  us  to  expect  a  necessity  for  mental  and 
physical    rest,  even   when  no   pain   was   experienced? — the 
capital  question  of  the  Essay. 

It  is  evident  that  the  answers  to  all  these  questions 
depend  on  the  Theory  of  Menstruation,  and  this  is  as  yet  far 
from  being  established  upon  immovable  foundations.. 


SECTION    III. 

THEORY    OF    MENSTRUATION. 

AT  the  beginning  of  this   Essay,  a  few  quotations  were 
made,  showing  some  of  the  various  opinions  that  had 
been  held  upon  this  interesting  topic.     These  opinions  may 
be  divided    into   three   classes,  which   roughly  correspond  to 
three  epochs,  of  very  unequal  duration. 

The  first  is  the  Theory  of  Plethora,  which  considered  the 
menstrual  flux  to  represent  the  nutriment,  in  excess  over  the 
•wants  of  the  individual,  provided  for  the  wants  of  the  foetus. 
With  this  view  was  generally  associated  a  cosmic  theory,  by 
which,  in  virtue  of  its  peculiar  periodicity,  the  menstrual  flux 
was  associated  with  the  phases  of  the  moon,  or  other  cosmic 
phenomena.  This  theory  prevailed  more  or  less,  from  the 
time  of  Hippocrates  to  the  time  of  Pouchet. 

The  second  is  the  famous  Ovulation  Theory,  distinctly 
formulated  about  1845,  which  construes  the  menstrual  hemor- 
rhage as  a  subsidiary  phenomenon,  entirely  dependent  on 
the  periodical  dehiscence  of  ovules.  Around  this  theory  has 
clustered  the  most  brilliant  gynecological  literature  of  modern 
times.  Yet  'this  famous  theory  is,  in  these  last  few  years, 
.ing  attacked  and  hard  pressed  on  all  sides,  and  seems  likely 
to  yield  place  to  a  third,  scarcely  yet  defined  enough  to  have 
a  name,  according  to  which  ovulation  and  the  menstrual 
hemorrhage  are  processes  coincident  but  distinct,  the  latter 
being  subsidiary,  not  to  changes  in  the  ovary,  but  in  the 
uterus  preparatory  for  a  pregnancy.  For  our  purpose  it  is 
worth  while  to  examine  each  of  these  theories  a  little  closely, 
but  not  in  the  order  stated.  The  ovulation  theory,  by  right  of 
preeminence,  holds  the  first  place,  and  must  be  examined  first. 


OVULAR   THEORY.  65 

In  the  discussion  of  the  ovular  theory,  it  is  not  necessary 
to  repeat  in  detail  the  history  of  its  establishment,  which  has 
been  related  so  frequently  (see  Pouchet,  Courty,  Ritchie, 
Raciborski,  etc.).  For  our  purpose  it  is  sufficient  to  dwell 
upon  the  following  circumstances  that  have  occasioned  the 
most  discussion.  These  are,  the  development  of  the  Graafian 
vesicle ;  the  origin  and  nature  of  the  ovule ;  the  periodicity 
or  continuity  of  its  growth  ;  the  cause  of  its  dehiscence  ;  the 
relation  of  this  in  point  of  time  to  the  menstrual  hemorrhage  ; 
the  succession  of  changes  occurring  in  the  uterus  in  connec- 
tion with  the  flow  ;  the  relations  of  the  hemorrhage  to  con- 
ditions of  general  nutrition,  of  the  nervous  system,  or  of 
vascular  tension,  etc. 

Negrier '  asserted  that  at  birth  the  ovaries  were  homo- 
geneous ;  that  the  primary  vesicles  appeared  during  the 
first  year,  and  first  began  to  attain  any  size  towards  the  tenth 
year.  Cruveilhier  says :  "  They  (the  ovaries  of  the  foetus) 
contain  a  certain  number  of  very  small  vesicles,  or  rather 
granulations." — Anat.  Descrip.,  T.  III.,  p.  649.  1843. 

According  to  Raciborski 2  all  anatomists  adopted  the 
opinion,  until  lately,  that  the  ovaries  of  the  foetus  contained 
only  the  germs  of  the  Graafian  vesicles,  around  which  these 
latter  were  formed  some  years  after  birth.  This  author  also 
credits  Sappey  with  the  discovery,  that  in  the  ovary  of  a 
child  two  years  old  existed  400,000  follicles.3  But  in  1837, 
Carus  4  already  described  Graafian  vesicles  in  young  children. 
In  1864,  Henle5  counted  the  follicles  in  the  ovary  of  the  new- 
born, and  estimated  them  at  360,000. 

The  researches  of  Pfluger  on  the  origin  of  the  follicles 
date  from  1863.  All  modern  anatomists  agree  that  "the 
formation,  development,  and  maturation  of  the  Graafian 
vesicles  and  ova  continue  uninterruptedly  from  infancy  to 

1  Recherches  sur  les  Ovaires.  2  Loc.  cit.,  p.  51. 

3  Traite  d'Anatomie  Descriptive.    1867.  4  Mullers  Archiv.    1837. 

6  Handbuch  der  Systematisch  Anat.,  Bd.  II.,  p.  484. 

5 


66  THE   QUESTION   OF   REST   FOR   WOMEN. 

the  end  of  the  fruitful  period  of  woman's  life."1  "The 
Graafian  vesicles  arc  formed  already  in  the  foetus  and  in  the 
new  born,  but  they  are  also  found  in  the  adult.2  This  last 
statement  is  formally  contradicted  by  \Valdeyer.  "  The  fol- 
licles," says  this  distinguished  observer,  "appear  first  at 
eighteen  or  twenty  weeks  of  fcetal  life.  At  this  time  they 
contain  the  ovule,  and  a  simple  lining  of  epithelial  cells, 
much  smaller  than  the  egg  cell."3  In  1863,  Pfluger'1  de- 
scribed the  Graafian  follicles  as  originating  in  tubular  pro- 
longations from  the  peritoneal  epithelium,  that  dip  down 
into  the  vascular  stroma  of  the  ovary.  At  a  period  when 
the  stroma  is  not  yet  solid,  it  is  easy  to  distinguish  these 
tubes.  YValdeyer  compares  their  invasion  to  that  of  the 
hair  follicles  and  sebaceous  glands  in  the  skin.  As  they 
penetrate,  the  extremity  near  the  surface  becomes  gradually 
constricted  and  finally  closed,  and  surrounded  by  a  network 
of  conjunctive  tissue.  This,  by  two  and  a  half  years,  has 
formed  a  thick  capsular  layer,  surrounding  the  ovum.11  At 
this  time  the  ovary  has  almost  the  same  structure  as  in  the 
adult  (Waldeyer).  "  Follicles  more  or  less  ripe,  indistinguish- 
able by  any  sign  from  those  of  adult  women,  may  be  found 
in  the  ovaries  of  girls  from  one  week  to  fourteen  years  old."  G 
Ritchie,  in  1865,  relates  in  detail  three  autopsies  of  children 
— one  at  birth,  one  at  sixteen  weeks,  one  at  five  and  one- 
half  years.  In  each  case  the  'surface  of  the  ovaries  was 
smooth  ;  but  in  the  first,  two  vesicles,  in  the  third,  seven  or 
eight,  were  found,  while  the  interior  of  the  second  was  found 
to  be  thickly  studded  with  extremely  delicate  vesicles,  vary- 

1  Gray,  Human  Anatomy,  p.  753.  2cl  Ed.   1860.  p.  710.   1870. 

-  Beaunis  et  Bouchard,  Elements  d'Anatomie  Descriptive,  p.  829. 

3  Die  Eierstocke,  p.  21.     1871; 

4  Ueber  die  Eierstocke  du  Saugethiere. 

5  Klebs,  Die  Eierstocke  der  Saugethiere  und  Vogel.   Arch.  Vircho\v.   Bd.  28. 
1863. 

6  Grobe,  Ueber  der  Ban  und  das  Wachsthum  des   menschlichen  Eierstocks 
Arch.  Vircli.     Bd.  26. 


^HISTOLOGY  OF  GRAAFIAN   VESICLES.  67 

ing  in  size  from  a  pin's  head  to  a  mere  point,  and  filled  with 
a  milky  fluid.  In  the  ovary  from  the  child  of  five  years  old, 
the  largest  vesicle  was  the  size  of  a  mustard  seed,  had  an 
opaque  capsule,  and  contained  a  reddish  colored  coagulum. 
The  capsule  of  another  was  of  a  brick  red  color,  and  con- 
tained a  coagulum  of  lighter  shade  in  its  central  part,  but 
surrounded  by  a  delicate  disc  of  what  appeared  to  be  dark 
colored  blood.1  Two  differences,  according  to  Waldeyer, 
principally  distinguish  the  ovary  of  the  new  born  from  that 
of  the  adult.  The  layer  of  conjunctive  tissue  surrounding 
the  follicles  (albuginea)  consists  of  one  thin  layer  of  fibres,  and 
little  follicles  still  lie  together  in  grape  shaped  groups. 
His  and  Grobe  describe  important  changes  in  the  stroma,  and 
insist  upon  its  increased  vascularization,  observed  at  the 
approach  of  puberty ;  but  from  the  time  that  the  tubes  are 
once  converted  into  circular  follicles,  the  structure  of  these 
latter  remains  essentially  the  same.  Henle  (loc.  cit.)  says 
that  the  wall  of  the  follicle  consists  of  a  Tunica  fibrosa  and 
Tunica  propria  folliculi,  the  first  derived  from  the  ovarian 
stroma,  the  second  developed  from  the  lining  membrane  of 
cells — membrana  granulosa.  Waldeyer  admits  the  existence 
of  these  two  layers,  but  derives  both  of.  them  from  the 
stroma  of  the  ovary,  in  which  the  original  tubular  prolonga- 
tion of  cells  had  been  imbedded.  This  is  also  the  opinion 
of  Klebs.  Slaviansky  describes  the  same  membranes  under 
the  name,  "  Perifollicular"  layer,  as  distinguished  from  the 
parenchyma,  and  admits,  with  Henle,  a  membrana  propria, 
rich  in  round  cells,  and  an  external  layer  of  loose  reticulated 
conjunctive  tissue,  composed  of  fibres  and  fusiform  cells. 
The  membrana  propria,  whose  existence  is  denied  by  Klebs, 
is  described  by  Slaviansky  as  the  basement  membrane  under- 
lying the  epithelial  cells  of  the  membrana  granulosa.  It  is 
easily  seen  in  fresh  specimens,  is  originally  endothelial,  as 
can  be  demonstrated  by  staining  with  silver,  but  finally  loses 

1  Contributions  to  Ovarian  Physiology  and  Pathology,  p.  16.  1865. 


68  THE   QUESTION   OF    REST    EOR   WOMEN. 

its  nuclei.  It  does  not  exist  in  the  primordial  follicles  (\Val- 
deyeri.  The  parenchyma  of  the  follicle  (Slaviansky),  or  con- 
tents (\Yaldeyer),  consists  of  the  membrana  granulosa,  or 
the  epithelial  cells  lining  the  follicle,  the  liquor  folliculi,  appa- 
rently derived  from  swollen  ami  dissolved  cell  protoplasma, 
finally,  the  ovule  surrounded  by  its  discus  proligerus.  The 
small  follicles  measured  50-60  u.,  the  larger  1-1.5  mm>  the 
ovules  35-10  u.  Ritchie  says,  the  follicles  vary  in  size  from 
the  bulk  of  a  coriander  seed  to  that  of  a  small  raisin.  The 
principal  difference  of  opinion  between  Pfluger  and  Waldeyer 
refers  to  the  precise  origin  of  the  ovum  cell.  Pfluger  de- 
scribes certain  large  cells  with  clear  nuclei,  distinguishable  in 
the  mass  of  germinal  epithelium  of  the  abdomen,  which  may 
be  seen  in  the  embryo  to  enter  the  open  mouths  of  the  flask- 
shaped  prolongations.  These  he  considers  to  be  the  original 
ova,  and  hence  distinct  from  the  epithelium  of  the  follicle. 
But  according  to  Waldeyer,  the  ovum  is  derived  from  one  of 
these  epithelial  cells,  which  simply  increases  in  size.  The 
ovule  and  epithelium  are  both  therefore  directly  derived  from 
the  germinal  epithelium  on  the  surface  of  the  ovary.  Thus 
remotely,  from  the  mass  of  cells  constituting  the  Wolffian 
bod\-.  His1  demonstrates  that  the  reproductive  cell  must 
be  an  epithelium,  since  its  capacity  for  growth  is  required  to 
transcend  that  of  all  other  elements,  and  this  capacity  per- 
sists longer  in  epithelial  tissues  than  any  other.2  Schroen's 
opinion  that  the  membrana  granulosa  is  derived  from  con- 
nective tissue  is  in  disaccord  with  the  philosophical  necessity 
is  justly  insisted  upon  by  His.3 

1    Unsere  Korper  Forme,  p.  152.   1875. 

Rapidity  is  in  inverse  proportion  to  duration  ;  the  nervous  system  is  most 
rapidly  developed,  and  earliest  arrested  in  its  growth,  so  that  it  cannot  be  regen- 
erated after  birth.  The  epithelium  is  the  slowest,  and  growth  persists  after  birth. 
'1  he  muscular  tissue  is  intermediate  between  the  two.  See  also  remarks  of  Paget, 
that  "epithelial  structures  are  liable  to  spontaneous  death  and  extrusion,  as  hair, 
teeth,  cpidermi,."— Surgical  Pathology,  p.  3.  The  ovule,  as  an  epithelial  structure, 
would  .-.imply  follow  this  general  law. 

8  Spencer  (Prin.  Biol.,  p.  221)  observes  that  these   modified   epithelium   cells 


DEVELOPMENT   OF   FOLLICLES   BEFORE   PUBERTY.        69 

So  far  therefore  as  regards  the  complete  Graafian  vesicles, 
containing  completed  ova,  it  is  certain  that  they  exist  long 
before  puberty,  or  the  establishment  of  menstruation,  and  that 
not  in  a  rudimentary  condition,  but  large  and  completely 
formed. 

Nor  is  this  all.  The  gradual  increase  in  size  of  the  ovum, 
known  as  the  process  of  its  "  ripening  or  maturation,"  fol- 
lowed by  a  peculiar  retrogression  or  atrophy,  is  also  observed  in 
childhood.  The  function  of  the  ovary  (maturation  of  folli- 
cles), is  exercised  not  only  in  adult  women,  but  before  men- 
struation, and  during  childhood.'  But  when  during  childhood 
the  follicles  have  attained  the  size  of  a  pea  or  over  they  do  not 
rupture,  but  are  submitted  to  a  physiological  involution.  This 
differs  from  that  following  rupture,  when  a  corpus  luteum  is 
formed,  in  that  it  is  effected  by  a  sclerosis,  instead  of  fatty 
degeneration.  The  cavity  becomes  filled  with  a  granular 
mass  composed  of  fusiform,  round  and  oval  cells,  upon  which 
the  wall  retracts  irregularly  until  finally  no  trace  of  the  follicle 
remains  but  a  grayish  spot  representing  the  cicatrice.'2 
Waldeyer  declares,  that  the  abortion  of  ovules  continues  not 
only  throughout  childhood,  when  they  never  rupture,  but 
also  in  adult  life.  "  Ovaries  contain  many  multiple,  folded 
homogeneous,  brilliant  membranes  surrounding  a  granular 
and  fibrous  mass,  which  can  hardly  be  interpreted  otherwise 

are  not  remarkable  for  their  complexity,  but  rather  for  their  simplicity.  They 
are  cells  which  have  departed  but  little  from  the  original  and  most  general  type. 
Not  peculiarly  specialized,  rather  unspecialized.  It  is  well  known  that  Kolliker 
derived  spermatozoa  from  epithelium. 

1  Slaviansky,  Loc.  cit. 

8  The  entire  evolution  of  the  vesicle  would  therefore  be  effected  by  prolifera- 
tion of  its  cellular  contents.  But  after  puberty  the  perifollicular  layer  is  more 
vascularized,  and  an  increase  of  tension  in  its  blood  vessels,  causes  an  effusion  of 
fluid  into  the  cavity.  The  pressure  exerted  upon  this  fluid  by  the  stroma,  is 
transmitted  to  the  point  on  the  wall  where  there  is  the  least  resistance,  causing 
their  gradual  thinning  and  final  rupture.  A  phenomenon  of  simple  cell  nutrition 
has  been  replaced  by  one  dependent  on  hyperaemia  and  changes  in  blood 
tension. 


-O  THE    QUESTION    OF    REST    FOR   WOMEX. 

than  as  the  remains  of  aborted  follicles.1  In  1864,  Hcnle  de- 
scribed these  same  cicatrices  consisting  of  "  a  brilliant  struct- 
ureless multiple  folded  membrane,  forming  a  vesicle  filled  with 
conjunctive  tissue,  and  which  are  probably  to  be  considered  as 
simply  collapsed  follicles."  '  Ritchie  maintains  that  the  Graaf- 
ian  vesicles  even  rupture  during  childhood,  but  then  by  circu- 
lar shaped  capillary  sized  pores,  through  which  the  transparent 
granular  fluid  may  be  discharged.  The  cicatrices  left  by  the 
rupture  of  vesicles  that  coincides  with  menstruation,  and 
after  the  formation  of  a  corpora  lutea  vcl  menstrulia,  are 
linear  and  irregular. 

"  Cicatrices  are  found  on  the  surface  of  children's  ovaries, 
indicating  the  ripening  of  follicles,  but  there  is  no  observation 
upon  human  beings  showing  that  previous  to  puberty,  an 
ovum  has  escaped  from  a  Graafian  follicle.  Puberty  and  sex- 
ual maturity  do  not  depend  upon  the  state  of  development 
of  the  Graafian  follicle  and  ovule,  because  these  exist  from  the 
second  or  third  year.  The  ovule,  germinal  vesicle  and  germ- 
inal spot,  have  almost  the  same  dimensions  as  in  adultss  but 
in  the  latter,  the  number  of  ripe  Graafian  vesicles  is  somewhat 
larger  than  in  the  child.  During  childhood  the  ripe  follicles 
undergo  a  retrograde  metamorphosis  without  bursting.  The 
Liquor  folliculi  is  gradually  absorbed,  the  membrana  granu- 
losa  falls  into  fatty  degeneration,  the  cavity  becomes  smaller, 
the  ovule  granular,  and  finally  dissolves." 

Ritchie  has  abundantly  demonstrated  the  presence  of 
large  Graafian  vesicles,  filled  with  transparent  fluid,  project- 
ing above  the  level  of  the  ovary,  apparently  just  ready  to 
burst,  in  the  bodies  of  women  who  had  died  in  childbed,  or 
after  the  persistence  of  prolonged  pathological  amenorrhea. 

1  I.oc.  cit.  p.  27. 

5  Whether,  observes  Henle,  the  follicle  which  contains  a  ripe  ovum  must  neces- 
sarily bur.-,t :  whether  the  bursting  only  takes  place  at  the  time  of  menstruation, 
or  at  other  times,  in  consequence  of  coitus,  .  .  .  are  questions  to  which  no 
answer  at  present  can  be  given.  Handbuch.  Bd.  II.  p.  483. 


POUCHET'S  LAWS.  71 

:  The  positive  evidence  for  the  existence,  progressive  de- 
velopment, and  regressive  atrophy  of  the  Graafian  vesicles 
and  ova  both'  previous  to  the  attainment  of  reproductive 
powers,  and  at  various  periods  in  relation  to  menstruation, 
and  the  consequent  independence  of  this  process  upon  that 
of  menstruation,  is  negatively  much  strengthened  by  a  care- 
ful examination  of  the  evidence  upon  which  the  theory  of 
dependence  has  been  based. 

The  original  advocates  of  this  theory,  more  especially 
Bischoff,1  Raciborski,"  and  Pouchet,3  were  first  of  all  occu- 
pied in  proving  that  the  bursting  of  the  Graafian  vesicle, 
and  dehiscence  of  the  ovule,  occurred  spontaneously,  and 
independent  of  coitus.  The  exclusive  association  of  this  de- 
hiscence with  menstruation,  was  originally  a  pure  deduction, 
line  vue  cC  esprit,  adopted  as  a  corollary  from  the  experiments 
which  discovered  ruptured  vesicles  in  the  lower  animals,  sacri- 
ficed during  the  rut,  during  which  period  they  had  been  sedu- 
lously isolated.  Pouchet  announces  the  following  ten  Laws, 
as  resuming  the  Theory  which,  according  to  Virchow,  has 
revolutionized  all  our  ideas  in  regard  to  this  great  depart- 
ment of  Anthropology.4 

1.  The  human  species  and  mammiferae  are  subjected  to 
the  same  fundamental  laws. 

2.  Throughout  the  animal  kingdom,  generation  is  effected 
by  means  of  ova  which  exist  previous  to  fecundation. 

3.  Many  obstacles  oppose  the  possibility  of  contact  be- 
tween the  seminal  fluid  and  ovules  still  contained  in  the 
Graafian  follicles. 

4.  Fecundation  can   only  take  place  when  the  ovum  has 
acquired  a  certain  degree  of  development  after  its  separation 
from  the  ovary. 

1  Beweis  ueber  der  Begattung.  1854.  -  Traite  de  la  menstruation. 

3  Theorie  del'Ovulation  spontanee.     It  is  accepted  unequivocally  by  Courty, 
Longet,  Liegois,  Brucke,  Virchow,  Beaunis,  etc.     It  has  always  been  disputed  by 
Aran. 

4  Gesammdt.  Abhandlungen,  p.  736. 


72  THE   QUESTION   OF   REST    FOR   WOMEN. 

5.  Throughout  the  animal  series,  it  is  incontestable  that 
the  ovary  discharges  its  ovules  independently  of  fecundation. 

6.  In   all  animals  ovules  are  emitted  at   fixed  epochs,  in 
relation    with    the    periodical    surexcitation    of    the    genital 
organs. 

7.  In  the  human   species,  and  the   mammiferae,  fecunda- 
tion  never  occurs,  except  when  the  emi.-ssion  of  ovules  coin- 
cides with  the  presence  of  the  seminal  fluid. 

8.  The   menstruation  of  the  woman   corresponds   to  the 
phenomena  of  excitement,  which  is  manifested  at  the  rutting 
seasons  in  various  animals,  and  especially  in  the  females  of 
the  mammiferae. 

9.  Fecundation  is  in  constant  relation  with  menstruation  ; 
therefore    in    the    human    species    it    is    easy  to    rigorously 
establish  the   intermenstrual  epoch  at    which  conception  is 
physically  impossible. 

10.  In  the  human  species  and  mammiferae,  the  ovule  and 
the  sperm  normally  encounter  each  other  in  the  uterus  and 
the  neighboring  region  of  the  Fallopian  tubes,  and  it  is  here 
that  fecundation  takes  place. 

Against  the  first  five  of  these  laws  the  most  scrutinizing 
modern  researches  have  failed  to  raise  the  least  objection. 
It  is  quite  otherwise  with  the  sixth,  and  it  is  important  to 
examine  carefully  the  proofs  upon  which  so  weighty  a  law>is 
made  to  repose.  Those  are  divided  by  Pouchet  into  two 
classes,  direct  and  indirect.  The  direct  proofs  are  as  follows  : 
In  the  entire  biological  series,  when  the  organism  of  the  animal 
has  reached  its  maximum  of  development,  certain  phenomena 
are  exhibited  by  the  sexual  organs,  indicating  a  profound  ex- 
citement, and  soon  afterwards,  the  ovary  increases  in  size,  the 
ovules,  which  had  been  in  a  latent  state  and  of  extremely  min- 
ute dimensions,  grow  rapidly,  and  when  they  are  sufficiently 
organized  to  be  efficaciously  impregnated,  they  are  expelled 
from  the  germiferous  organ,  and  carried  towards  the  exterior. 
In  many  Invertebrates,  especially  insects,  the  organism  is  ex- 


POUCHET'S   SIXTH    LAW.  73 

hausted  by  a  single  crisis  of  ovulation.  In  the  lower  Verte- 
brates, as  fish  and  reptiles,  the  turgescence  of  the  ovary  only 
occurs  once  a  year,  at  the  same  epoch  that  the  testicles  of  the 
male  increase  in  size.  Where  ovulation  and  fecundation  are 
normal,  they  are  effected  at  a  time  of  the  year  most  favorable 
for  the  development  of  the  unprotected  eggs.  In  oviparous 
animals,  domesticity,  which  increases  chances  of  protection, 
markedly  diminishes  the  interval  between  the  rutting  seasons. 
Nevertheless,  after  every  period  of  excitement  an  egg  is  laid, 
and  in  mammiferae  as  shown  by  the  experiments  of  Cruik- 
shank,'  Haighton,51  Bischoff,3  De  Baer,4  when  the  Fallopian 
tubes  have  been  tied  at  the  beginning  of  the  rut,  the  Graafian 
vesicles  are  found  ruptured,  the  ovum  escaped,  and  often  to 
be  detected  in  the  oviduct. 

Pouchet  himself  only  describes  observations  of  corpora 
lutea  found  in  animals  dead  during  pregnancy  or  after  partu- 
rition, and  alleges  them  as  proof  that  the  follicles  rupture  with- 
out the  influence  of  coitus  or  the  contact  of  the  seminal  fluid. 
He  also  describes  the  ovaries  of  two  young  girls,  virgins, 
which  offered  Graafian  vesicles  in  various  stages  of  develop- 
ment, and  also  corpora  lutea,  showing  that  these  latter  had 
formed  without  fecundation.  But  those  observations,  while 
proving  the  spontaneous  development  and  dehiscence  of  the 
ovules,  do  not  afford  the  least  proof  that  the  latter  only  oc- 
curs at  the  epoch  of  the  rut.  As  already  observed,  the  crucial 
experiments  of  Raciborski  and  Bischoff,  who,  dissecting  vir- 
gin mammiferae  after  the  epoch  of  the  rut,  discovered  ova  in 
the  Fallopian  tubes,  proves  that  the  Graafian  vesicles  burst 
at  this  time,  but  does  not  disprove  that  they  burst  at  any 
other. 

Bischoff  was  fortunate  enough  to  examine  the  ovaries  of 
four  women,  who  died  during  menstruation.6  In  three  of  the 

1  Phil.  Trans.  1797.  *  Phil.  Trans.  1797. 

3  Loc.  cit.  4  Epistola  de  ovi  mammalium.  1872. 

8  Beweis  der  period.  Reifung  und  Loslosung  der  Eier.   1844. 


74  THE    QUESTION    OF    REST    FOR    WOMEN. 

cases  were  found  a  Graafian  vesicle  ruptured  and  filled  with  a 
clot  of  blood  :  but,  in  ttic  fourtJi,  only  an  unruptured  vesicle. 
Pouchct  himself  has  never  had  the  opportunity  to  make  a 
similar  observation?  and  he  contents  himself  with  purely 
deductive  reasoning.3  "  Since  in  the  mammiferae,  the  epoch 
of  the  rut  is  also  that  of  the  excitement  of  the  Graafian  follicles, 
and  of  the  expulsion  of  ovules  ;  as  this  period  is  equally 
marked  in  many  mammiferae  (sow,  ape)  by  an  oozing  of 
blood  more  or  less  apparent  upon  the  surface  of  the  internal 
genital  apparatus ;  finally  as  it  has  been  shown,  that  female 
mammiferae  which  have  been  castrated  no  longer  manifest 
the  phenomena  of  the  rut,  and  that,  according  to  Robert, 
menstruation  ceases  in  the  women  of  central  Asia  who  have 
been  submitted  to  this  cruel  operation  :  it  must  be  conceded 
that  phenomena  which  have  the  same  seat,  the  same  causes, 
the  same  effects,  are  phenomena  not  only  analogous,  but  per- 
fectly identical."  (p.  227.)  Again,  (p.  244)  in  the  chapter 
dedicated  to  showing  the  identity  between  menstruation  and 
the  rut,  ( ~th  Law)  Ponchet  says  :  "  In  women,  as  has  been 
proved  by  observation  on  the  mammifercz,  it  should  be  during 
this  period  that  the  Graafian  vesicles  develop  and  experience 
the  internal  hemorrhage  destined  to  expel  the  ovule  formed 
in  their  cavity,  but  they  do  not  yet  open.  The  difficulty  of 
observations  in  regard  to  this  subject  in  the  human  species, 
only  permits  us  to  support  our  view  by  analogy :  but  in  this 
case,  the  analogy  is  so  evident  that  it  is  impossible  to  resist 
it.  ...  It  is  entirely  at  the  end  of  the  catamenial  flow, 
that  the  follicles  open  and  their  ova  are  expelled. 

"  The  difficulties  afforded  by  autopsies  prevent  us  from  prov- 
ing this  in  the  human  species,  but  the  observation  of  the  great 
mammifcrce  render  the  assertion  not  doubtful."  We  believe, 
on  the  contrary,  that  the  great  variety  in  the  phenomena  of 

1  Loc.  cit.  p.  240. 

-  It  is  this  chain  of  reasoning  which  constitutes  his  so-called  "  Indirect  Proof" 
of  the  Positive  theory  of  Ovulation. 


MENSTRUATION   AND   THE   RUT.  75 

the  rut  offered  by  different  species  and  classes '  of  animals, 
and  especially  the  variability  in  its  repetition  according  to 
variations  in  the  habitus,  media,  etc.,  of  the  same  animals, 
should  strictly  forbid  us  from  drawing  inferences  from  any  of 
the  lower  animals  to  be  unqualifiedly  applied  to  the  human 
race. 

In  regard  to  this  mode  of  reasoning,  we  think  Ritchie's 
remarks  are  perfectly  applicable  :  "  The  reasoning  of  many, 
at  present,  on  the  connection  of  menstruation  with  the 
emission  of  the  contents  of  the  ovarian  follicles,  resembles 
that  formerly  employed  on  the  relation  of  impregnation  to 
what  are  termed  corpora  lutea,  for  as  there,  the  corpora  lutea 
discovered  in  the  ovaries  of  animals  after  fecundation  were 
regarded  as  the  necessary  results  and  indubitable  proofs  of 
that  event,  to  the  exclusion  of  the  rut  which  went  before,  so 
now,  because  this  latter  condition  in  animals  is  always,  and 
the  process  of  menstruation  in  women  is  usually,  succeeded 
by  the  rupture  of  some  of  the  vesicles  of  the  ovaries,  the.se 
states  (rut  and  menstruation)  are  often  considered  as  the 
indubitable  consequences  of  the  periodical  extrusion  of  ova, 
to  the  shutting  Out  of  view  of  the  independent  vital  powers 
of  the  ovaries,  existing  antecedently  to  both,  and  of  which 
they  are  merely  correlative  effects." 

The  arguments  of  Wagner  (Handworterbuch,  art.  Zeugung, 
p.  878)  in  support  of  the  unqualified  dependence  of  menstrua- 
tion upon  the  bursting  of  a  Graafian  follicle  are  also  mainly 
analogical.  But  he  adduces  the  following  positive  evidence. 
If  menstruation  in  the  woman  really  signify  the  periodic 
return  of  that  condition  which  we  call  rut  in  a'nimals,  it  is 
above  all  necessary  that  it  be  shown  to  be  accompanied  by 
the  ripening  and  dehiscence  of  an  ovule ;  and  indeed,  after 
recent  experiments,  this  cannot  be  doubted.  .  ,  .  So  often 
as  the  corpse  of  a  woman,  whether  married  or  virgin,  has 
been  examined  during  menstruation  or  shortly  after,  has  a 
completely  ripe  or  else  a  burst  follicle  been  found.  The 


76  THE   QUESTION   OF   REST    FOR   WOMEN. 

author  refers  to  Eckcr,  Tanzer,  Ritchie,  Argenti,  Gerres, 
Hyrtl,  Leocatelli,  Lethcby,  Coste,  Meckel,  Hannover,  Ger- 
lach,  Dalton.  He  then  relates  three  cases  himself,  where  he 
found  a  corpus  luteum  at  the  time  of  menstruation. 

But  we  know  that  the  ovaries  are  sometimes  filled  with 
mature  vesicles,  and  ova  are  being  constantly  extruded,  in 
everv  form  of  amenorrhea,  and  during  the  normal  absence  of 
menstruation ;  and  also  that  this  latter  function  is  often 
accomplished  without  the  rupture  of  an  ovarian  follicle. 
Ritchie  quotes  the  autopsy  of  a  virgin  of  sixteen  who  had 
never  menstruated,  and  who  died  on  the  sixth  day  of  typhus 
fever.  Ovaria  were  covered  with  several  mahogany-colored 
points,  in  one  of  which  was  a  capillary-sized  foramen  which 
led  into  a  Graafian  vesicle  about  as  large  as  a  small  grape, 
in  which  was  a  little  blood. 

De  Sinety  relates  the  autopsy  of  a  woman  who  died  of 
phthisis  after  five  months  amenorrhea,  and  a  recently  rup- 
tured Graafian  vesicle  was  found  at  the  autopsy.  (Quoted 
in  American  Journal  of  Science.  July,  1874.) 

In  an  autopsy  recenth'  made  by  the  present  writer,  of  a 
woman  with  advanced  chronic  nephritis,  who  died  thirty 
hours  after  confinement  at  term,  vesicles  perfectly  correspond- 
ing to  Ritchie's  descriptions  were  found,  two  in  one  ovary, 
one  in  the  other. 

Williams  (Proc.  Royal  Soc.,  No.  162.  1875.  Journal 
Obstet.,  Feb.,  1876,  p.  7271)  quotes  twenty-eight  cases  exam- 
ined by  Reichert,  in  which  the  genital  organs  showed  signs 
of  menstruation.  In  one  case  the  follicle  had  ruptured.  In 
four  the  follicle  had  matured  before  hemorrhage  began,  in 
one  of  which  the  follicle  had  actually  ruptured,  and  hemor- 
rhage had  taken  place  into  the  decidua  menstrualis.  Reichert 
concludes  that  the  rupture  of  the  Graafian  follicle  takes  place 
at  an  early  stage  of  the  menstrual  flow.  Williams  examined 
sixteen  cases.  In  twelve  of  them  rupture  of  a  follicle  or 
hemorrhage  into  its  cavity  had  occurred  before  the  return  of 


DEHISCENCE   OF   OVULES.  77 

the  catanicnia  :  In  one  it  was  doubtful  whether  rupture  of  the 
follicle  or  the  appearance  of  the  discharge  would  have  taken 
place  first ;  in  two  a  menstrual  period  had  passed  without 
maturation  of  a  follicle  ;  and  in  one  a  periodical  discharge 
was  imminent,  though  the  ovaries  contained  no  matured  Graa- 
jian  follicle.  It  is  not  improbable  that  the  follicles  found  in 
the  three  last  cases,  and  which  were  enlarged  to  the  size  of  a 
pea,  would  have  become  matured  by  the  next  return  of  the 
flow.  Williams  concludes  that  the  rupture  occurs,  as  a  rule, 
before  the  appearance  of  the  monthly  flow  with  which  it  is 
connected.  We  think  the  just  inference  may  be  drawn,  that 
the  relations  of  the  rupture  of  the  Graafian  vesicle  to  the 
uterine  hemorrhage  are  very  variable  ;  or,  as  Tilt  says  (Loc. 
cit.  p.  28),  menstruation  and  ovulation  are  shown  to  be  paral- 
lel facts,  but  their  causal  dependence  is  by  no  means  proved. 
In  opposition  to  the  statements  which  assume  to  repose 
upon  such  an  accumulation  of  facts,  Beigel '  observes  that 
"  the  opinion  which  makes  menstruation  the  consequence 
and  expression  of  ovulation  is  supported,  apart  from  theoret- 
ical'grounds,  upon  a  very  few  cases,  in  which  ruptured  folli- 
cles have  been  found  in  the  ovaries  of  women  who  have  died 
•during  menstruation.  The  number  of  these  cases  is  extremely 
small,  and  the  consequences  which  have  been  deduced  from 
them  are  paralyzed  by  those  autopsies  where  death,  having 
also  occurred  during  menstruation,  such  follicles  have  not 
been  found.  Ashwell  has  had  occasion  to  examine  three 
cadavers  whose  ovaries,  although  death  took  place  during 
menstruation,  offered  no  traces  of  a  rupture  of  a  Graafian 
follicle.  In  one  of  these  the  woman  had  menstruated  regu- 
larly for  many  years  ;  yet  the  ovaries  were  perfectly  smooth. 
Beigel  also  quotes  the  famous  autopsy  of  Maria  Manning, 
performed  by  Paget,  as  affording  a  weighty  demonstration 
against  the  ovulation  theory.  Twelve  hours  before  death 
the  woman  began  to  menstruate.  At  the  examination  the 
1  Die  Krankheiten  des  weiblichen  Geschlechts.  Bd.  I.  p.  307.  .1874. 


78  THE    QUESTION    OF    REST    FOR    WOMEN. 

ovaries  were  found  of  a  medium  size,  and  covered  by  numerous 
cicatrices.  In  the  right  ovary,  three  Graafian  follicles  pro- 
jected somewhat  above  the  surface,  appeared  healthy,  and 
were  filled  with  a  clear  serous  fluid.  A  fourth  follicle  was 
very  large.  The  left  ovary  contained  a  completely  developed 
and  prominent  Graafian  follicle.  Ovules  were  sought  for  in 
vain.  The  surface  of  the  ovaries  was  somewhat  more  vascu- 
lar than  usual,  and  there  was  one  place  especially  vascular- 
i/.ed,  but  not  the  least  trace  of  the  recent  rupture  of  a  vesicle 
or  dehiscence  of  an  ovum.  In  the  right  ovary  was  a  little 
cyst,  or  several  months  old  corpus  luteum.1 

That  the  dehiscence  of  the  ovule  is  not,  in  the  human 
species,  exclusively  associated  with  menstruation,  may  indeed 
be  positively  proved  by  all  the  cases,  now  tolerably  numerous, 
i,f  conception  at  intermenstrual  periods.  Pouchet  is  so  con- 
vinced of  the  necessity  of  this  corollary  from  his  sixth  law 
that  has  been  formulated  in  his  ninth,  that  he  insists  with 
vehemence  on  the  impossibility  of  fecundation  except  at 
periods  approaching  that  of  menstruation.  Raciborski,  how- 
ever, is  compelled  to  admit  that  this  so  called  law  is  not 
invariable.  The  writer  of  this  Essay  is  acquainted  with  at 
least  eight  cases,  where  conception  was  effected  fourteen  days 
after  a  menstrual  period.  In  three  other  cases,  avoidance  of 
marital  intercourse  during  the  first  twelve  days  after  men- 
struation preserved  sterility,  while  conception  took  place  as 
soon  as  this  period  was  invaded.  But  even  a  few  opposite 
examples,  and  they  could  certainly  be  abundantly  multiplied 
by  the  experience  of  every  physician,  are  sufficient  to  throw 
discredit  on  the  doctrine  which  places  dehiscence  of  ripened 
ova  exclusively  in  the  fortnight  immediately  following  a 
menstrual  period. 

Dr.  Oldham  says  :  "  Cases  arc  known  to  me  where  con- 
ception has  occurred  ten,  twelve,  twenty-one  days  after  the 

1  \\e  shall  refer  again  to  this  autopsy  in  speaking  of  the  vascular  phenomena 
of  menstruation. 


CONCEPTION   AT    MENSTRUAL   PERIODS.  79 

cessation  of  menstruation,  and  although  I  am  prepared  to 
admit  a  greater  disposition  for  conception  immediately  after 
the  monthly  flux,  I  nevertheless  possess  no  facts  that  should 
contradict  the  opinion  that  the  human  female  may  be  im- 
pregnated at  any  time  after  the  menses."  ' 

Beigel  quotes  Hirsch2  as  giving  a  case  where  conception 
occurred  twenty-two  days  after  cessation  of  the  menses. 
The  author  lays  stress  on  the  well-known  fact,  that  among 
the  Jews  intercourse  is  forbidden  during  five  days  before  and 
seven  days  after  the  menstrual  flow,  yet  the  fertility  of  this 
people  is  remarkable. 

These  facts  are  of  all  the  more  importance,  on  account  of 
the  mass  of  evidence  which  has  been  accumulated  to  show  that, 
until  the  Graafian  vesicle  has  ruptured,  the  ovum  cannot  be 
fecundated.  In  some  cases  where  coitus  at  intermenstrual 
periods  has  proved  fruitful,  it  has  been  assumed  that  the 
spermatozoa  have  remained  in  this  canal  until  the  menstrual 
period  following  their  entrance,  when  an  ovum  is  liberated  to 
meet  them.  This  is  the  interpretation  offered  by  Dr.  Ward, 
of  a  case  where  conception  was  effected,  nine  days  before  the 
period  of  menstruation,  which,  however,  did  not  take  place.3 
But  this  explanation  is  a  pure  assumption  based  on  the  un- 
qualified acceptance  of  the  theory,  that  the  dehiscence  of 
ova  never  occurs  except  at  a  menstrual  period. 

From  what  precedes,  two  facts  of  importance  for  our  pur- 
pose may  be  considered  acquired :  First.  The  formation  of 
ova  is  a  nutritive  phenomenon  that  exists  throughout  child- 
hood, and  therefore  before  the  acquisition  of  reproductive 
powers,  or  the  exercise  of  sexual  functions.  In  its  origin  and 
appearance  a  simple  epithelial  cell/  the  ovum  developes  and 

1  Quoted  by  Tilt,  Ovarian  Inflammation,  p.  67.    1862. 

2  Said  to  be  in  Schmidt's  Jahrbucher,  1854,  but  I  have  been  unable  to  verify 
the  quotation. 

3  New  York  Medical  Journal.    1875. 

4  Although  even  before  fecundation  it  has  ceased  to  be  a  cell,  and  has  devel- 


SO  THE   QUESTION   OF   REST   FOR   WOMEN. 

atrophies  according  to  the  laws  governing  epithelial  tissues. 
Second  :  The  characteristic  change  in  the  history  of  the 
Graafian  vesicles  that  is  observed  at  puberty  is  their  rupture 
when  arrived  at  a  certain  size,  which  rupture  is  followed  by 
an  escape  of  the  ovule  and  its  descent  into  the  uterus.1  In 
animals  the  phenomena  of  the  rut  are  constantly  accompanied 
by  the  rupture  of  one  or  more  follicles,  and  in  a  certain 
number  of  autopsies  of  human  females,  similar  conditions  have 
been  found  to  coincide  with  menstruation.  But  it  is  peremp- 
torily demonstrated,  both  by  autopsies,  and  by  the  fact  of 
intermenstrual  conceptions,  (tf)  that  the  rupture  of  folliculus 
may  occur  not  only  independently  of  coitus  but  in  the  absence 
of  menstruation  ;  (A>  that  menstruation  and  coitus  may  occur 
without  the  rupture  of  follicles.  The  description  of  the  au- 
topsy given  on  page  78,  shows  that  the  hyperaemiam  question- 
ably present  in  uterine  tissues,  (or  part  of  them)  at  the  time  of 
menstruation,  extends  to  the  ovarian  stroma,  and  even  to  the 
perifollicular  layer  of  the  Graafian  follicle.  Now  it  is  indubit- 
able that  uterine  hemorrhage,  indistinguishable  in  appearance 
or  clinical  phenomena  from  that  of  menstruation  frequently 
occurs  under  the  influence  of  any  cause  that  cither  accelerates 
the  circulation,  or  raises  arterial  tension,  or  both.  Hence  the 
"  uterine  epistaxis,"  in  the  first  stage  of  fevers,2  or  the  "  bringing 
on  of  the  courses,"  under  the  influence  of  agitating  emotions 
The  advocates  of  the  ovular  theory  of  menstruation,  should 
suppose  in  these  cases,  that  the  ripening  of  a  Graafian  follicle 
had  been  hastened  by  the  acceleration  of  the  circulation,3  and 
that  "the  irritation  "  thus  produced  had  occasioned  the  men- 
oped  to  a  complex  organism  by  fusion  with  elements  from  the  discus  proligerus. 
(Waldeyer.) 

1  A>  we  have  seen,  some  authors  admit  a  peculiar  kind  of  rupture  even  during 
childhood,  but  we  do  not  think  this  to  be  sufficiently  proved. 

5  Pointed  out  by  Gubler. 

3  We  saw  the  other  day  a  lymphatic  gland  in  the  neck  of  an  infant,  that  had 
been  long  indolently  engorged  after  nasal  irritation,  suddenly  begin  to  suppurate 
at  the  moment  that,  with  increasing  health,  the  circulation  became  more  active. 


PFLUGER'S   THEORY.  8  I 

strual  hyperaemia.  But  it  is  purely  gratuitous  to  assume  this 
necessity,  and  certainly  inconsistent  with  theory  of  a  fatally 
periodical  cycle  in  the  ripening  of  the  ovarian  bud.  In  the 
few  cases,  (we  do  not  at  this  moment  recall  any,)  where  fol- 
licules  have  been  ruptured  coincidsntly  with  such  irregular 
"  menstruations,"  the  rupture  must  be  considered  the  conse- 
quence of  the  rise  of  vascular  tension,  not  its  cause.  In  these 
cases  at  least,  that  cause  is  admitted  to  be  general. 

We  say  these  facts  are  of  considerable  importance  for  our 
purpose,  because  since  the  promulgation  and  almost  universal 
acceptance  of  the  ovulation  theory,  the  peculiar  changes  sup- 
posed to  take  place  in  the  Graafian  vesicles  at  each  menstrual 
period  have  been  supposed  to  involve  a  peculiar  expenditure 
of  nerve  force,  which  was  so  much  dead  loss  to  the  individual 
life  of  the  woman.  The  idea  that  menstruation  was  the  ex- 
pression of  sexual  excitement,  existed  before  the  ovulation 
theory  (Lecat.  Emett,  see  ut  supra,)  and  is  still  maintained 
by  such  writers  as  Beigel  who  nevertheless  reject  this  latter 
theory  altogether.  Nevertheless,  it  is  principally  under  its 
influence  that  the  growth  of  the  Graafian  vesicle  and  of  its 
contained  ovum,  has  come  to  be  regarded  on  an  entirely  dif- 
ferent plane  from  the  nutritive  phenomena  of  other  cells,  and 
as  causing  a  special  irritation  of  the  nerves  of  the  ovary,  re- 
flected to  the  entire  nervous  system.  According  to  Pfluger  the 
gradual  accumulation  of  this  irritation,  finally  determines  by 
reflex  transmission  the  afflux  of  blood  to  the  uterus  and 
ovaries  which  constitutes  the  catamenial  flow.1  According  to 
Rouget,  whose  theory  we  must  presently  examine  in  detail, 
this  irritation  is  sufficiently  intense  to  determine  a  true  erec- 
tion of  all  the  internal  organs  of  generation.  Now  whatever 
view  may  be  held  of  the  periodical  hyperaemia  of  these 
organs,  we  believe  that  sifting  of  the  evidence  leaves  no 
plausible  pretext  to  separate  the  growth  of  the  generative 

1  This  theory  is  adopted  by  Barnes  and  many  other  gynecologists. 
6 


82  THE   QUESTION   OF    REST    FOR    WO.MEX. 

epithelium  from  the  general  phenomena  of  nutrition,  nor  to 
ascribe  to  it  any  special  nervous  or  sexual  influence. 

Indeed  the  assumption  (for  it  is  scarcely  more,  though  so 
imposingly  supported  by  authority)  of  a  periodical  nervous 
crisis  excited  by  a  periodical  development  of  reproductive 
cells,  serves  to  confound  the  two  aspects  of  the  reproductive 
apparatus  in  women  which  ought  to  be  kept  entirely  distinct, 
namely,  the  reproductive  and  the  sexual.  Reproduction  is 
essentially  a  process  of  nutrition.1  From  the  lowest  infuso- 
ria'2 to  man,  the  fusion  of  two  cells,  either  derived  from  one 
individual  (agamogenesis)  or  two  (gamogenesis),  each  cell 
concentrating  in  itself  molecules  representative  of  the  organ- 
ism from  which  it  is  derived,3  constitutes  the  essence  of  this 
mighty  physiological  process.  As  sex  is  secondary  to  the 
necessity  for  complex  development,  of  which  it  is  a  conse- 
quence,4 so  sexual  instinct  and  excitement  are  entirely  subor- 
dinate to  this  fundamental  fact  of  the  increase  in  the  powers 
of  development  of  one  cell  by  the  absorption  of  the  material, 
and  by  the  influence  of  the  molecular  forces  of  another.5 
This  sexual  fusion  is  again  a  simple  extension  of  an  earlier 
intraovular  fusion,  apparently  necessary  to  complete  the 
maturity  of  the  female  cell,  or  fusion  between  the  vesicle  of 
Balbiani  and  the  germinal  vesicle  (Balbiani,  Bernard,  Loc.  cit.). 

The  perfectly  mature  ovule  indeed  cannot  be  considered 
as  a  simple  cell.  The  follicular  epithelium  combines  with 
it,  having  first  formed  the  discus  proligerus.  Already,  there- 
fore, a  complex  organism  has  developed  from  the  originally 

1  Sec  Claude  Bernard's  Lectures  at  the  College  of  France,  published  in  the 
Revue  des  Cours  Seientiliques.  1874. 

•  See  Balbiani,  Sexual  Generation  in  Infusoria  ;  Journal  Brown-Sequard, 
T.  I.  1858. 

3  Darwin.  Theory  of  Pangenesis  ;  Variations  of  Animals  under  Domesticity. 
Galton,  Journal  of  Authropolog,  Institute,  1876. 

4  Spencer,  Principles  of  Biology  ;  Hirth,  Marriage  of  Near  Kin. 

5  See  Haeckel,  Anthropogenic  ;  His,  Loc.  cit. 


REPRODUCTION   IN    WOMAN.  83 

simple    epithelial    cell,    before    it   becomes   surrounded   by 
spermatoza. 

The  sexual  instinct  or  impulse  is  necessarily  absent  in 
certain  large  classes  of  animals  ;  namely,  in  all  who  propagate 
asexually,  or  by  the  fusion  of  cells,  both  of  which  are  derived 
from  the  same  individual ;  and  must  exist  in  a  modified  form 
in  all  oviparous  animals,  as  fishes,  in  which  ova  are  fecundated 
after  complete  separation  from  the  body  of  the  female.  Now 
it  is  precisely  in  these  animals  that  the  periodical  growth  of 
ovaries  assumes  the  most  marked  proportions  ;  in  other  words, 
the  phenomena  of  reproduction  are  effected  principally  by  the 
one  element  of  increased  nutrition.  The  extrusion  from  the 
body  of  the  products  of  such  increased  nutrition  is  accom- 
plished without  sexual  congress,  and  in  a  manner  analogous 
to  the  processes  of  defecation  and  micturition.  In  animals 
in  whom  the  union  of  the  sexes  is  essential  to  fecundation, 
whether  the  eggs  be  impregnated  while  still  in  the  body  of 
the  female,  or  at  the  moment  of  emission,  as  in  frogs,  a 
curious  difference  exists  between  the  two  sexes  in  regard  to 
the  expulsion  of  the  reproductive  cell.  In  the  female,  this 
occurs  spontaneously;  in  the 'male,  normally,  only  as  the 
result  of  sexual  intercourse.  The  theory  of  spontaneous 
ovulation  means  precisely  that  in  the  female  the  essential 
part  of  reproduction  can  be  effected  without  any  sexual  act. 
The  superior  contribution  to  the  nutritive  element  of  repro- 
duction made  by  the  female  is  balanced  by  an  inferior  de- 
pendence upon  the  animal  or  sexual  element ;  in  other  words, 
she  is  sexually  inferior.  This  is  still  true  even  when  the 
manifestation  of  sexual  instinct  coincides  with  the  dehiscence 
of  ova,  since  the  gratification  of  the  instinct  is  not  necessary 
in  order  that  the  eggs  may  be  laid.  It  is  especially  true  of 
the  human  female,  in  whom,  in  the  immense  majority  of 
cases,  ova  dehisce  when  the  sexual  instinct  is  not  only 
ungratified  but  unawakened.  This  statement  would  hold 
even  were  it  proved  that  the  dehiscence  of  ova  took  place 


84  THE   QUESTION    OF    REST    EOR   WOMEN. 

exclusively  at  menstruation,  but  since,  from  what  precedes, 
this  famous  doctrine  is,  after  all,  unproved,  the  separation  of 
the  sexual  and  nutritive  elements  of  reproduction  in  the 
woman  must  be  considered  to  be  complete. 

But  the  Graafian  follicles,  however  important,  do  not 
comprise  the  entire  tissue  of  the  ovary,  nor,  even  in  the 
ovular  theory,  docs  the  dehiscence  of  ova  constitute  all  the 
phenomena  characteristic  of  the  establishment  of  puberty  or 
of  menstruation.  As  regards  the  ovaries,  the  most  impor- 
tant changes  observed  as  the  period  for  menstruation  ap- 
proaches, are  to  be  found  in  the  stroma  and  blood  vessels. 
We  have  already  mentioned  Waldeycr's  remark  that  the 
albuginea  becomes  much  denser  at  this  age.  He  attributes 
its  increase  to  the  nutritive  irritation  exercised  on  the  stroma 
by  the  constantly  developing  follicles  imbedded  in  it.  As 
the  ovary  grows  older,  the  stroma  is  further  modified  by  the 
great  increase  of  blood  vessels,  and  also  by  the  presence  of 
smooth  muscular  fibres.  The  arteries  of  the  ovary  are  early 
developed,  and  become  helicine  like  those  of  the  uterus. 
Extremely  numerous  branches  reach  the  periphery  of  the 
organ  and  the  Graafian  follicles,  and  these  are  much  more 
highly  vascularized  at  puberty  than  during  childhood  (Grobe, 
\\~aldeycr,  Ritchie).  At  the  base  of  the  ovary  exists  a 
plexus  of  bloodvessels  so  rich  as  to  constitute  a  tissue  anal- 
ogous to  the  corpora  cavernosa,  and  which,  since  Rouget, 
has  been  called  the  bulb  of  the  ovary.  It  is  this  physiolo- 
gist, in  a  memoir  become  famous,1  who  has  described  with 
the  most  care  the  vascular  tissue  of  the  internal  organs  of 
generation,  demonstrating,  by  means  of  injections,  a  richness 
of  bloodvessels  hitherto  unsuspected. 

Rouget  first  describes  minutely  the  disposition  of  blood- 
vessels in  erectile  tissues,  disputing  Miller's  assertion  that  in 
these  the  arteries  terminate  in  culs  de  sac,  and  describes  them 

1  Journal   de    Physiol.,   Brown-Sequard,    1859.     Rouget's   thesis  was   passed 
in  1855. 


ROUGET'S  THEORY.  83 

as  forming  bouquets  whose  branches  twist  themselves  into 
brusque  spirals,  interlaced  and  anastomosed  into  vascular 
knots.  These  persist  during  erection,  instead  of  being  effaced 
as  would  be  simple  flexuosities.  The  veins  and  capillaries  also 
form  enormous  dilatations  and  anastomoses,  and  the  whole 
vascular  mass  is  contained  in  meshes  of  smooth  muscular 
trabeculae.  Such  erectile  tissue  exists  at  the  hilus  of  the 
ovary,  in  the  parenchyma  of  the  ovary,  and  above  all  in  the 
body  of  the  uterus,  but  exclusively  in  the  human  female .  No 
other  mammifer  presents  a  development  of  vessels  sufficiently 
considerable  relative  to  the  parenchyma  to  constitute  erectile 
tissue.  When  the  utero-ovarian  vessels  were  injected,  the 
entire  pelvis  being  placed  in  a  vessel  of  warm  water,  the 
body  of  the  uterus  rose  in  the  pelvis  and  remained,  ascended 
and  curved  forward,  so  long  as  the  erectile  tissues  were  dis- 
tended. The  same  phenomenon  was  observed  in  the  ovary, 
but  less  marked  ;  no  change  took  place  in  the  Fallopian  tube. 

Rouget's  descriptions  and  diagrams  have  been  copied  into 
most  systematic  treatises  on  diseases  of  women.1 

His  description  of  the  muscular  fibre  of  the  ovary  is  as 
remarkable  as  that  of  the  bloodvessels.  Before  examining 
that  of  the  human  female,  he  describes  muscular  planes  in 
various  animals,  which  so  envelop  the  ovary  as  to  guide  the 
eggs  to  the  oviducts.  In  cartilaginous  fishes,  the  eggs  fall 
into  the  peritoneum,  where  many  are  lost.  Those  which  sur- 
vive are  pushed  towards  the  oviduct  by  contractions  of  the 
abdominal  walls.  In  scaly  reptiles,  the  muscular  layer 
(mesoarium)  envelops  the  oviduct  and  ovary,  and  in  contract- 
ing draws  them  together.  In  birds  (the  hen),  the  mesoarium 
is  very  well  developed,  and  can  be  seen  with  the  naked  eye. 
In  birds  the  peritoneal  fold  (broad  ligament)  essentially  con- 
sists of  muscular  fibres.  "  In  women  this  muscular  tissue 
does  not  form  a  continuous  membrane,  but  a  species  of 

1  See  Courty,  also  Thomas,  Diseases  of  Women :  Grailley  Hewitt.  Liegois, 
Traite  de  la  Physiologic. 


86  THE    QUESTION    OF    REST    FOR    YVOMEX. 

canvas  with  large  meshes,  mixed  with  muscular  and  nervous 
fibres,  the  whole  covered  and  masked  by  conjunctive  tissue. 
The  characteristic  muscular  fibre  cells  can  only  be  obtained 
close  by  the  surface  of  the  membranous  ligaments  of  the 
peritoneum.  Between  the  two  folds  which  form  this  surface 
we  liardly  find  anvtliing  but  cellular  tissue,  vessels,  and  nerves. 
The  muscular  fibres  are  not  easy  to  demonstrate  on  the  child 
or  nitlliparons  woman.  But  during  pregnancy,  and  for  a  long 
time  afterward,  no  more  doubt  is  possible."  Three  systems 
of  fibres  are  demonstrated.  The  first  arise  from  the  round 
pubic  ligament,  and  spread  fan-shaped  the  entire  height  of  the 
uterus,  interlacing  with  those  of  the  opposite  side.  The 
second  come  from  the  posterior  surface  of  the  uterus,  and 
form  the  ligament  of  the  ovary.  They  do  not  terminate 
abruptly  at  its  internal  extremity,  but  radiate  into  the  stroma 
of  the  gland,  inclosing  Graafian  follicles  in  their  meshes. 
This  is  also  admitted  by  Groher,  but  Waldeyer  denies  that 
the  muscular  fibre  reaches  the  follicles.  He  and  Henle  and 
His1  have  found  them  forming  sheaths  around  the  arteries  in 
the  medullary  portion  of  the  ovary,  but  not  extending  fur- 
ther than  the  limit  of  the  parenchymatous  zone.  The  third 
system  described  by  Rouget  should  constitute  the  lumbar 
ligament,  which,  however,  is  more  difficult  to  demonstrate. 
They  are  said  to  start  from  the  lumbar  region  and  uterus, 
embrace  the  entire  length  of  the  Fallopian  tube1  and  the 
fimbriated  portion,  and  by  their  contraction,  draw  the  latter 
down  upon  the  ovary,  close  over  the  most  prominent  vesicle. 
"  This  contraction  results  from  the  reflex  irritation  that  has 
been  caused  by  the  distension  of  the  ovarian  stroma  when 
the  Graafian  vesicles  reach  a  certain  degree  of  develop- 
ment." This  reflex  irritation  is  propagated  to  all  the  mus- 
cular apparatus  of  the  internal  genital  organs.  The  ovario- 
tubal  fibres  contract  (ut  supra),  the  contraction  causes  com- 
pression in  the  muscular  networks,  and  the  blood  is  forced 
1  Described  also  by  Hennig,  Der  Katarrh,  p.  3. 


THEORY   OF   ROUGET. 


87 


back  from  the  ovarian  plexus,  distending  the  spongy  bodies 
of  the  uterus,  until  finally,  under  the  increased  pressure,  the 
bloodvessels  of  the  uterine  mucous  membrane  are  ruptured. 
Hence  the  menstrual  hemorrhage." 

This  theory  has  obtained  an  immense  influence.  Courty 
observes  that  "  by  artificial  erection  of  the  uterus  and  ovary 
on  the  cadaver  we  can  demonstrate  their  true  erectility,  and 
the  part  it  plays  in  ovulation,  menstruation,  copulation." 
These  views  again  probably  have  had  much  to  do  with  the 
habit  of  considering  menstruation  as  a  local  congestion,1  and 
unquestionably  have  done  much  towards  confirming  the 
supposed  analogies  between  menstruation  and  the  rut,  while, 
on  the  other  hand,  they  have  themselves  been  guided  by 
these  analogies. 

It  is  unquestionable  that  the  tissue  of  the  ovary  becomes 
vascular  at  puberty,  and  smooth  muscular  fibre  cells  mingle 
with  conjunctive  tissue  of  its  stroma.  The  entire  bulk  of  the 
organ  is  somewhat  increased  in  size.  At  birth  it  measures 
about  1.3  c.  m.  in  length,  1-6  c.  m.  in  breadth,  and  3  to  3.5 
min.  in  thickness.  In  the  adult  female  it  is  3.8  c.  m.  long, 
2  c.  m.  broad,  and  15  mm.  thick.2  The  few  examples  of 
herniated  ovaries  that  have  been  utilized  for  science,  have 
shown  that  the  bulk  somewhat  increases  during  menstrua- 
tion, and  also  the  vascularity.  This  latter  has  been  demon- 
strated in  autopsies.3  But  between  these  moderate  variations 
and  the  "  erection  "  supposed  to  be  demonstrated  by  Rouget, 
especially  the  mechanism  of  the  erection  by  reflex  contrac- 
tion of  muscular  fibres  so  delicate  that,  until  they  have  been 
developed  in  pregnancy,  their  existence  can  scarcely  be 
demonstrated,  between  these  two  sets  of  facts  lies  a  wide 
distance.  We  believe  the  following  substantial  objections 
are  to  be  urged  against  Rouget's  theory : 

1  Peaslee,  New  York  Medical  Record.   1876.    Barnes,  however,  denies  the  appro- 
priatenessof  this  expression  (Clinical  Lectures).  See  below,  Kundrat  and  Williams. 
9  Beaunis,  Anat.  Descriptive.  8  See  p.  173  and  p.  181. 


88  THE   QUESTION   OF   REST   FOR   WOMEN. 

1.  Even  admitting  (and  we  do  not  admit)  that  at  each 
menstruation   the  utero-ovarian  plexus  of  blood  vessels  be- 
comes   as    full\-    distended    as    in    Rouget's  injections,    such 
injection  would  not  of  itself  constitute  an  erection.     Bouquets 
of  arteries,  enclosed  in  the  meshes  of  conjunctive  tissue,  and 
tr.ibccul.-c  containing  muscular  fibres,  exist   in  the  spleen  as 
well  as  in  the  erectile  tissues.      Here  also  are  all  provisions 
for  sudden  accumulations  of  blood,  causing  great  distension 
of  the  organ,  yet  no  one  would  describe  them  as  erections. 
The  distinction  is  of  much  practical  importance,  because  this 
term  necessarily  implies   such   intense  excitation  of   certain 
cercbro-spinal  centres   as   must,  for   the   time,  interfere   with 
the  activity  of  many  others. 

2.  Erectile    tissues    are    everywhere    external,   developed 
from  the  epiblast  or  embryonic  fold  of  animal  life;  while  the 
internal   organs  of  generation   develop   in  the  hypoblast    or 
nutritive  layer,  the  primitive  intestine.     The  predominance 
in  women  of  the  internal  over  the  external  organs  of  genera- 
tion is  an  indication  of  the  predominance  in  them  of  repro- 
duction over  sexuality,  not.  as  Rouget  supposes,  of  a  transfer 
of  the  seat  of  the  sexual  sense. 

3.  During  menstruation  sensation  is  either  absent  or  pain- 
ful.   The  cases  where  a  conscious  sexual  instinct  is  awakened 
at  this  period,  are  decidedly  in  the  minority.1     When  painful 
sensations  exist,  they  are  either  in  the  form  of  cramps,  burn- 
ing, or  weight.     In  the  latter  case  the  uterus  does  not  rise  in 
the  pelvic  cavity,  but  sinks,  which  is  manifestly  opposed  to 
both  the  theory  and  experiment  of  Rouget. 

I  have  noticed  some  exceptions  to  this  rule.  In  the  case 
of  an  anemic  and  sterile  woman,  who  habitually  felt  well  dur- 
ing menstruation,  and  the  week  preceding,  but  languid  and 
exhausted  during  the  other  two  weeks,  I  found  the  uterus 
retroverted,  the  examination  being  made  at  this  latter  time. 
No  local  pain  or  discomfort  was  experienced  from  the  dis- 
1  Bischoff  in  a  famous  memoir  tries  to  evade  and  then  explain  this  difficulty. 


THEORY   OF   ROUGET.  89 

placement.  On  examining  the  day  before  menstruation,  the 
uterus  was  found  to  be  in  place, — literally  erected. 

4.  The  helicine  arteries  of  the  uterus  and  ovarian  bulb 
have  long  been  regarded  as  a  provision  for  pregnancy.  It 
has  indeed  been  shown  that  their  flexuosities  do  not,  as  was 
supposed,  disappear  during  pregnancy,  and  that  the  arteries 
never  become  straight.1  But  the  flexuosities  permit  of  the 
accumulation  of  a  greater  quantity  of  blood  during  a  longer 
time  than  would  be  the  case,  if  the  blood  vessels  were 
straight.  Hence  an  admirable  provision  for  the  nutrition  of 
the  foetus.  Moreover,  as  by  the  flexures  in  the  cerebral  blood 
vessels  delicate  tissues,  (in  this  case,  those  of  the  embryo,) 
are  saved  from  the  shock  to  which  they  would  be  exposed, 
were  the  great  mass  of  blood  required  for  their  nourishment, 
poured  directly  upon  them.  In  a  normal  condition,  the  blood 
that  flows  to  the  utero-ovarian  plexus  at  menstruation,  passes 
off  as  rapidly  as  it  flows  in.2  A  stasis  of  blood  in  the  parenchyma 
of  uterus  or  ovaries  immediately  induces  symptoms  which 
are  foreign  to  perfectly  healthy  menstruation.  On  the  other 
hand,  when  conception  has  taken  place,  the  same  accumula- 
tion of  blood  will  be  effected  without  causing  any  feeling  of 
local  distress.  It  is  not  at  all  uncommon  even  for  women  who 
habitually  suffer  pain  at  menstruation,  to  pass  six  or  seven 
weeks  of  pregnancy  without  being  warned  by  any  pelvic  sen- 
sation of  the  physiological  hyperaemia  of  the  pelvic  viscera. 
In  women  who  suffer  from  slight  prolapsus  or  chronic  uterine 
congestion,  the  disappearance  of  the  dragging  sensations 
about  the  loins  that  had  become  habitual,  often  constitutes 
one  of  the  first  signs  of  pregnancy. 

The  writer  recalls  at  this  moment,  four  well  marked  illus- 
trations of  this  fact.  This  shows  that  if  the  rapidity  of  circu- 
lation through  the  ovarian  plexus,  be  proportioned  to  the  ex- 

1  Barnes,  as  well  as  others,  insists  on  this  fact. 

8  See  p.  97.      Williams,  description  of  uterine  parenchyma  during  menstru- 
ation. 


90  THE   QUESTION   OF    REST    FOR   WOMEN. 

cess  of  blood  in  it,  no  sensation  results  from  the  hyperaemia, 
h  o  \v  e  v  e  r  e  n  o  r  m  o  u  s . 

5.  But  the  mechanism  imagined  by  Rouget  implies,  not 
an  increased  flux,  but  an  increased  stasis  of  blood,  whose  re- 
turn through  the  uterine  veins,  is  impeded  by  the  contraction 
of  muscular  fibres.  We  think  it  is  impossible,  even  through 
Rouget's  own  descriptions,  to  admit  the  succession  of  phe- 
nomena he  so  graphically  and  imaginatively  describes.  The 
existence  of  planes  of  muscular  fibre  surrounding  the  ovary 
in  other  animals,  especially  the  ovipara;  does  not  afford  even 
a  presumption  that  similar  planes  exist  in  women  except  in 
a  rudimentary  form.  Nothing  is  more  common  than  to  find 
in  the  higher  animal,  and  especially  in  man,  rudiments  of 
structures  more  fully  elaborated  in  lower  animals.  Rouget's 
description  in  women  is  entirely  of  rudimentary  muscular 
fibre  cells,  and  even  these  can  scarcely  be  demonstrated  ex- 
cept upon  the  pregnant  or  recently  parturient  woman. 
Again,  Rouget  insists  on  the  fact  that  these  fibres  can  only 
be  obtained  near  the  surface  of  the  peritoneal  folds.  The 
lamina:  that  pass  over  the  bulb  of  the  ovary  are  too  much 
attenuated  to  exercise,  by  their  contraction,  any  serious 
compression  of  the  vessels  in  the  hilus.  Yet  it  is  to  such 
compression  causing  a  reflux  of  blood  towards  the  uterus, 
that  the  author  ascribes  the  entire  "  congestion  "  that  should 
precede  the  menstrual  hemorrhage.  Moreover,  an  obstacle 
afforded  to  the  circulation  at  this  point,  should  not  com- 
pletely dam  up  the  pampiniform  circulation,  since  as  Rouget 
himself  points  out,  this  plexus  has  three  outlets,  into  the 
pudic  veins  below,  the  uterine  veins  in  the  middle,  and  into 
the  ovarian  veins  only  above. 

We  believe,  therefore,  that  Rouget's  famous  theory  of 
erection  is  not  only  unproved  but  untenable. 

1.  Because  the  disposition  of  blood  vessels  described  by 
him  exists  in  relation  to  pregnancy. 

2.  Because  autopsies  of  menstruating  women  have  never 


THEORY   OF   ROUGET.  9! 

discovered  a  distension  of  these  blood    vessels  in  any  way 
comparable  to  that  produced  by  his  injections  on  the  cadaver. 

3.  Because  the  sensations  of  the  woman  in  the  early  weeks 
of  pregnancy,   or  during  a  normal  menstruation,  show  that 
the  subjective  expression  of  pelvic  hyperaemia  is  very  differ- 
ent from  that  of  stasis. 

4.  Because  the  phenomenon  of  erection  does  not  depend 
exclusively  upon  distension  of  cavernous  tissues  with  blood, 
but  implies  special  phenomena  of  innervation,  absent  in  the 
menstrual  flux  in  the  great  majority  of  cases.     It  often  hap- 
pens in  regard  to  this  point,  that  the  theory  invents  facts, 
where   the   facts   themselves   would    never   have   suggested 
the  theory. 

5.  Because  erectile  tissues,  belonging  to  the  sphere   of 
animal  life,  are  developed  from  the  animal  layer  of  the  blast- 
oderm, or  epiblast,  while  the  generative  intestine  of  the  woman 
is  derived  from  the  nutritive  layer  or  hypoblast. 

6.  Because  the  muscular  fibres  in  the  peritoneal  folds  are 
rudimentary  except   during  pregnancy,   are    superficial,  and 
cannot  be  shown  to  compress  the  deep  seated  blood  vessels 
at  all. 

7.  Because  even  were  such  compression  exercised  at  the 
bulb  of  one  ovary,  abundant  outlets  exist  for  the  return  of 
blood  elsewhere,  so  that  an  accumulation  of  blood  by  this 
mechanism  is  doubly  inconceivable. 

8.  Because  the  evidence  which  has  been  adduced  to  show 
that  Graafian  vesicles  may  develop  to  their  full  size  without 
the  occurrence  of  uterine  hemorrhage,  shows  that  such  devel- 
opment does  not  necessarily  cause  an  irritation  capable  of  ex- 
citing reflux  muscular  contractions.     This  latter  evidence  has 
been  accumulated  since  Pfluger's  Essay. 

In  considering  the  remarkable  phenomenon  of  the  men- 
strual flux,  two  distinct  questions  require  to  be  answered, 
namely : 

Why  does  blood  flow  to  the  uteri  ovarian  plexus,  and  why 


92  THE   QUESTION   OF   REST   FOR   WOMEN. 

docs  it  flow /><>;//  the  uterine  mucous  membrane.  Pouchet 
(see  ut  supra)  by  dissections  of  several  domestic  mammiferael 
showed  clearly  enough  that  during  the  rut,  the  uterine 
mucous  membrane  was  hyperaemiated.  He  even  insists  that 
a  certain  amount  of  sanguinolent  discharge  takes  place  in 
these  animals,  and  explains  its  minute  quantity  in  com- 
parison with  that  of  women,  by  the  abundant  space  offered 
by  the  lax  tissues  of  the  internal  generative  organs  in  which 
blood  may  accumulate.  This  explanation  has  never  been 
accepted  as  completely  satisfactory.  Nor  does  an  increased 
tension  in  the  uterine  blood  vessels,  sufficiently  explain  the 
hemorrhage,  since  here,  as  in  all  other  organs,  very  great 
congestion  may  exist  without  causing  a  rupture  of  the  ves- 
sels, even  the  capillaries.  The  imminence  of  this  event,  is 
in  proportion  to  the  laxity  of  the  tissues  supporting  the  ves- 
sels ;  hence  greatest  in  the  brain,  then  the  spleen,  perhaps 
last  of  all  in  the  parenchyma  of  the  uterus  composed  of  dense 
fibrous  unyielding  tissue.  Hence,  as  will  be  seen,  the  ex- 
treme rarity  of  hemorrhage  below  the  level  of  the  mucous 
membrane. 

It  is  only  the  internal  surface  of  the  uterus,  where  the 
least  facility  exists  for  rupture  of  blood  vessels,  and  this  only 
in  one  case,  namely,  if  the  blood  vessels  ramifying  in  the 
endometrium  are  laid  bare  by  the  desquamation  of  its  epi- 
thelium. 

As  early  as  1847,  Pouchet  already  described  such  a  des- 
quamation. But  the  process  has  lately  been  much  more 
elaborately  investigated  in  two  memoirs,  already  become 
classical. 

The  first  is  by  Kundrat,  and  published  in  Strieker's  Med. 
Jahrbucher  for  1873,  (Heft.  2.) 

The  second  by  Williams,  in  the  London  Obstetrical  Journal, 
1875.  Both  memoirs  are  founded  upon  numerous  autopsies. 
We  will  quote  freely  from  these  investigations,  beginning 
with  those  of  Kundrat  as  the  earliest. 


KUNDRAT'S   RESEARCHES.  93 

In  a  state  of  complete  repose  between  the  menstrual 
periods,  the  uterine  mucous  membrane  is  only  one  millimetre 
thick  at  the  fundus  and  sides  of  the  organ,  and  diminishes  in 
thickness  towards  the  cervix  and  ostia  of  the  tubes. 

This  mucous  membrane  is  distinguished  by  a  character- 
istic conjunctive  tissue  rich  in  cells,  and  by  the  absence  of  a 
submuncosa.  The  straight  tubes  constituting  the  glands,  lie 
side  by  side  in  the  tissue,  almost  exclusively  composed  of 
spindle-shaped  or  round  cells,  packed  much  like  the  glands  in 
the  gastric  mucous  membrane.  There  are  no  muscular  fibres 
in  this  layer,  but  the  conjunctive  tissue  stretches  outwards 
towards  the  muscular  tissue.  The  glands  are  lined  with 
cylindrical  ciliated  cells  which  are  continuous  with  those 
covering  the  mucous  membrane  between  the  tubes. 

The  most  essential  difference  between  the  mucous 
membrane  before  and  after  puberty  is  in  the  glands.  In  a 
seven  months  foetus,  the  membrane  is  09 — 15  min.  thick, 
and  contains  no  glands.  These  first  appear  at  three  to  four 
years  of  age,  and  then  contain  round  cells.  They  are  more 
developed  in  the  tenth  year,  and  at  twelve  to  thirteen  begin 
to  branch. 

During  menstruation,  the  mucous  membrane  swells  from 
one  millimetre  to  three  or  six  millimetres  in  thickness,  is  soft, 
tumefied,  injected  in  spots  or  uniformly  reddened.  The 
openings  of  the  glands  aretf  enlarged,  and  a  whitish  opaque 
mucus  is  poured  out.  The  cells  of  the  glands  are  enlarged, 
(as  those  of  the  peptic  glands  during  digestion)  and  there  is  a 
multiplication  of  the  round  cells  of  the  conjunctive  tissue 
stroma.  The  blood  vessels  are  distended  with  blood.  All 
these  appearances  are  confined  to  the  superficial  layer  of 
mucous  membrane.  In  the  same  layer  occur  occasional  ecchy- 
moses.  There  is  no  proliferation  of  blood  vessels. 

These  appearances  are  presumed  to  be  characteristic  of 
menstruation,  because  found  to  coincide  with  the  presence 
of  recent  corpora  lutea  in  the  ovaries.  But  their  precise 


94  THE    QUESTION   OF    REST    FOR   WOMEN. 

relation  to  the  time  of  the  dehiscence  of  the  ovum  is  not  yet 
fixed.  It  can  be  concluded  however  that  these  alterations  do 
not  begin  and  end  with  the  menstrual  hemorrhage.  "  In  two 
girls  who  died  suddenly  several  days  before  the  period,  and 
in  others  in  which  no  recently  ruptured  follicle  would  be 
found,  the  mucous  membrane  was  already  swollen  to  two  and 
one-half  or  three  millimetres.  We  must  believe  that  the 
swelling  begins  a  long  time  before  the  period,  but  reaches  its 
maximum  at  this  time.  It  is  so  rare  to  find  an  absolutely 
normal  uterine  mucous  membrane,  that  we  must  infer  the 
period  of  repose  to  be  very  short." 

At  the  time  of  the  hemorrhage,  and  until  the  return  to 
the  normal  condition,  the  cells  are  cloudy,  and  filled  with  fat 
granules.  This  fatty  degeneration  involves  the  gland  cells, 
cells  of  interglandular  tissue  of  the  blood  vessels,  and  the 
epithelium  of  the  surface,  but  is  extremely  superficial.  "  It 
is  my  opinion,"  says  the  author,  "  that  these  alterations 
develop  independently  of  the  haemorrhage,  and  indeed  de- 
termine it,  because 

"I.  In  spite  of  much  more  intense  hyperaemia  in  the 
endometrium  of  the  pregnant  uterus,  no  haemorrhage  occurs, 
showing  that  hyperaemia  alone  is  insufficient  to  account  for 
the  menstrual  flow. 

"  2.  Haemorrhage  docs  occur  in  other  physiological  degen- 
erations of  the  uterine  mucous  ^nembranc,  as  at  the  end  of 
pregnancy.  Should  the  decidua  become  fatty  too  soon, 
haemorrhage  will  equally  occur  before  term. 

"  3.  In  the  menstruating  uterus,  there  is  never  any  extra- 
vasation, except  in  the  superficial  layer  where  the  fatty 
degeneration  occurs.  I  conclude  that  the  membrane  degen- 
erates because  no  vessels  are  developed  to  nourish  it  suffi- 
ciently in  its  tumefied  state,  and  that  the  superficial  vessels, 
thus  laid  bare,  rupture,  and  permit  the  oozing  of  blood." 

It  is  difficult  to  maintain  the  old  theory  that  the  uterine 
hemorrhage  coincides  with  the  bursting  of  a  Graafian  follicle, 


WILLIAMS'    RESEARCHES.  95 

for  at  that  time  the  uterine  mucous  membrane  is  in  the  most 
unfavorable  condition  for  the  reception  of  the  ovum. 

The  swelling  of  the  endometrium  above  described,  implies 
preparation  for  conception,  and  the  retrograde  metamorT 
phosis  is  the  consequence  of  the  failure  to  conceive.  "  The 
membrane  occasionally  thrown  off  in  dysmenorrhea,  implies 
an  exaggeration  of  the  normal  tumefaction  and  consequent 
fatty  degeneration." 

Williams'  researches  confirm  and  extend  Kundrat's  con- 
clusions. He  found  that  the  highest  point  of  development 
of  the  uterine  mucous  membrane  was  reached  three  days 
before  menstruation.  It  was  then  one-fourth  of  an  inch  thick, 
covered  with  small  white  spots,  shown  under  the  magnifying 
glass  to  be  little  pits,  at  the  base  of  which  were  the  orifices 
of  the  glands.  Thus  the  membrane  was  tumefied  above  the 
level  of  the  glands.  No  blood  vessels  existed  in  this  tume- 
fied portion.  Still  nearer  to  menstruation,  the  membrane 
was  dark  red,  thick,  smooth,  very  soft,  and  contained  innu- 
merable blood  vessels  running  parallel  to  the  glands.  But 
of  the  two  women  on  which  this  description  is  based,  one 
had  succumbed  to  peritonitis.  In  four  other  cases,  where 
the  relations  to  the  menstrual  epoch  were  not  precisely 
known,  the  mucous  membrane  of  the  cervix  was  found  to 
terminate  abruptly  just  above  the  os  internum  in  an  excava- 
tion. Above  this,  the  endometrium  was  injected  and  tume- 
fied, or  else  desquamated.  The  epithelium  was  in  fatty 
degeneration,  and  very  superficial  hemorrhages  existed.  In 
two  cases,  where  death  took  place  on  the  fourth  day  of  men- 
struation, the  desquamation  of  the  mucous  membrane  above 
the  os  internum  was  complete.  The  muscular  fibres  were 
bare,  stained  with  blood,  and  covered  by  small  shreds,  com- 
posed of  round  and  fusiform  cells,  rod-shaped  bodies  like 
nuclei  of  muscle  fibres,  and  blood  corpuscles.  From  numerous 
points,  blood  exuded  on  pressure.  In  a  case  examined  just 
after  cessation  of  flow,  the  membrane  had  begun  to  regen- 


96  THE   QUESTION   OF   REST    FOR   WOMEN. 

erate  in  the  lower  two-thirds  of  the  cavity.  The  upper  third 
was  still  covered  with  brownish  shreds.  The  renewal  of  the 
lining  seemed  to  begin  from  the  cervix.  A  little  later,  the 
membrane  was  found  renewed  throughout,  but  epithelium 
was  still  absent.  Still  later,  the  membrane  was  found  com- 
plete, but  the  orifices  of  the  glands  on  a  level  with  the  surround- 
ing surface  ;  hence  the  development  was  inferior  to  that  ob- 
tained three  days  before  menstruation,  and  already  described. 

In  reviewing  these  twelve  autopsies,  Williams  remarks  : 
"  It  is  erroneous  to  study  the  menstrual  flow  as  a  process 
complete  in  itself,  or  to  attribute  it  to  a  simple  congestion  or 
a  prolonged  erection.  It  is  only  the  terminal  change  of  a 
cycle  of  changes,  which  begins  at  the  cessation  of  one  men- 
strual flow,  passes  through  the  developmental  phases  of  the 
mucous  membrane,  and  ends  with  the  cessation  of  the  flows 
next  following.  We  are  justified  in  affirming  that  there  is 
no  period  of  uterine  rest,  but  the  organ  is  ever  undergoing 
those  changes  which  either  make  it  a  fit  receptacle  for  the 
ovum  when  impregnated,  or  which  prepare  it  to  carry  off  the 
ovum  when  impregnation  has  failed.  If  any  one  stage  of 
the  month  could  appropriately  be  called  a  period  of  uterine 
inactivity,  it  would  be  the  bleeding  period,  for  it  is  then  that 
the  mucous  membrane  ceases  to  develop,  and  undergoes 
fatty  degeneration." 

The  author  attributes  the  hemorrhage  to  two  factors  : 

"  i.  The  desquarnation  of  the  endometrium,  by  which  the 
blood  vessels  are  laid  bare. 

"  2.  Contractions  of  uterine  fibres,  by  which  the  blood  is 
forced  towards  these  superficial  vessels.  The  uterine  walls 
are  found  pale  while  the  mucous  and  peritoneal  surfaces  are 
congested.  The  increased  quantity  of  blood  in  the  uterus  is 
determined  thither  by  the  active  processes  going  on  in  the 
development  of  the  mucous  membrane,  and  is  in  nowise 
allied  to  congestion.  The  flow  of  blood  attains  its  maximum 
at  the  time  the  proliferation  is  at  its  highest,  that  is,  a  short 


TWO  THEORIES  OF   OVULATION. 


97 


time   before   the  catamenia  appear.     With  fatty  degenera- 
tion, the  flow  is  suddenly  reduced." 

For  convenience  sake  we  will  contrast,  in  opposite  col- 
umns, the  sum  of  notions  in  regard  to  the  processes  involved 
in  menstruation,  that  have  been  acquired  in  the  last  few 
years  by  Waldeyer,  Slaviansky,  Grohe,  Kundrat,  Williams ; 
and  those  deduced  from  the  ovulation  theory  proper,  as  form- 
ulated by  Pouchet,  Raciborski,  Courty,  Rouget,  Pfluger,  etc. 


The  Graafian  vesicles  and  ova, 
are  either  absent  during  childhood, 
or  exist  in  a  comparatively  rudiment- 
ary state,  undergoing  no  progressive 
development. 


The  establishment  of  puberty  is 
principally  characterized  by  the  sud- 
den development  of  the  ovaries  and 
assumption  of  characteristic  func- 
tions in  the  ripening  of  ova. 


Graafian  vesicles  and  ova,  indis- 
tinguishable from  those  of  the  adult 
female,  are  found  in  the  ovary  at  all 
ages  after  two  years.  From  this 
time  no  new  vesicles  are  ever  formed, 
but  those  already  existing,  gradually 
and  successively  develop,  and  hav- 
ing reached  a  certain  maximum 
atrophy  without  rupture.  (It  does 
not  seem  to  have  been  ascertained, 
whether  the  fusion  with  the  vesicle 
of  Balbiani,  and  the  fusion  by  appo- 
sition with  the  epithelium  of  the  dis- 
cus proligerus,  that,  after  puberty 
are  essential  to  the  complete  matu- 
ration of  the  ovule,  ever  occur  before 
puberty.  Probably  not.) 

The  increase  of  size  of  the  ovaries 
during  the  three  or  four  years  pre- 
ceding menstruation  is  very  gradual, 
nor  is  there  any  such  development  of 
either  uterus  or  ovaries  as  justifies 
the  term  "  building  of  a  house  within 
a  house,"1  or  local  process  involving 
a  great  local  drain  upon  the  nutri- 
tion. The  essential  change  consists, 
not  in  the  size  of  the  Graafian  vesicle, 
but  in  its  increased  vascularization, 
and  the  secretion  of  fluid  into  its 
cavity,  leading  to  the  rupture  of  its 
walls  and  escape  of  the  ovum. 


1  Clark,  Sex  in  Education, 
7 


98 


THE   QUESTION   OF   REST   FOR   WOMEN. 


To  the  irritation  of  the  ovarian 
stroina  and  peritoneal  covering  of  the 
ovary,  caused  by  the  rapid  growth 
of  Graafian  vesicles,  is  due  the  afflux 
of  blood  to  the  uteri  ovarian  plexus, 
(I'flugerj  or  the  contraction  of  the 
muscular  fibres  which  causes  an  ac- 
cumulation of  blood  in  this  plexus 
by  impeding  its  return.  Congestion 
and  hemorrhage  are  the  consequence 
of  ovulation  and  the  dehiscence  of 
ova. 


1  The  distinction  between  buds  and 
botanists.  We  shall  refer  later  to  the 
Darwin.  Dalton  compares  the  Graafian 


The  effusion  of  serum  into  the 
Graafian  vesicles,  like  the  effusion  of 
liquor  amnii  into  the  cavity  of  the  de- 
veloped egg,  is  due  to  the  increased 
vascular  tension  in  the  blood  vessels 
of  the  ovarian  bulb,  and  ultimately 
of  those  ramifying  in  the  perifollicula 
layer  of  the  vesicle  itself.  This  in- 
creased tension,  and  the  increased 
afflux  of  blood  to  the  uteri  ovarian 
plexus  is  due  to  some  condition  en- 
tirely independent  of  the  develop- 
ment of  the  ova,  which  condition  only 
obtains  in  the  organism  long  after 
the  reproductive  cells  have  learned 
to  grow  to  maturity.  If  not  ovula- 
tion, at  least  dehiscence  of  ova,  is 
not  the  cause  but  the  consequence 
of  pelvic  hyperasmia.  The  surface 
of  the  ovary  on  which  the  follicles 
rupture  is  not  covered  by  peritone- 
um, (Waldeyer)  only  a  few  out  of  the 
immense  number  of  Graafian  vesicles 
contained  in  the  ovaries,  ripen  and 
rupture  at  any  one  time,  and  as  the 
process  of  their  complete  develop- 
ment is  gradual,  the  periods  of  rup- 
ture are  necessarily  intermittent. 
This  intermittence,  however,  far  from 
offering  a  type  of  physiological  peri- 
odicity, is  one  of  the  most  irregular 
of  physiological  phenomenas.  It  is 
not  to  be  compared  with  processes 
associated  with  rhythmic  movements 
of  the  circulation,  as  sleep  or  wake- 
fulness  in  the  brain,  digestion  or  re- 
pose in  the  stomach.  The  successive 
growth  of  the  Graafian  vesicles 
strictly  resembles  the  successive 
growth  of  buds  on  a  bough.1  It  is 
not  even  exclusively  associated  with 

seeds  has  much  perplexed  philosophic 
theories  of  De  Candolle,  Spencer  and 
to  the  dental  follicles. 


TWO   THEORIES   OF   OVULATION. 


The  ripening  and  dehiscence  of 
ova  occurs  periodically  at  the  epochs 
of  the  rut  in  the  lower  animals,  and 
of  menstruation  in  women.  It  is 
this  that  constitutes  the  essential 
part  of  both  processes,  and  these  are 
strictly  analogous  to  one  another. 
Menstruation  is  the  rutting  season 
for  women,  the  rut  is  the  menstrua- 
tion of  lower  animals. 


the  rhythmic  flux  constituting  men- 
struation, since  vesicles  do  not 
always  rupture  coincidently  with  this 
flux,  and  may  rupture  when  the  flux 
does  not  take  place.  The  perma- 
nent rise  of  tension  occasioned  by 
the  development  of  the  ovarian  blood 
vessels  at  puberty  seems  to  be  suffi- 
cient to  secure  the  mechanical  con- 
ditions needed  for  the  liberation  of 
ova. 

In  the  lower  animals,  in  whom 
the  sexual  instinct  exists  exclusively 
in  connection  with  reproduction,  the 
period  of  the  rut  and  the  rupture  of 
Graafian  vesicles  does  seem  to 
always  coincide.  At  least  several 
vesicles  are  always  found  ruptured 
in  animals  examined  after  this  period. 
There  is  no  proof,  however,  that  the 
congestion  of  erectile  tissues,  and 
the  rupture  of  Graafian  follicles, 
stand  in  any  causal  relation  to  each 
other,  but  rather  that  they  are  coin- 
cident phenomena. 

In  women  the  sexual  instinct  and 
reproductive  capacity  remain  dis- 
tinct ;  there  is  no  longer  any  neces- 
sary association  between  sexual  im- 
pulse, menstruation,  and  the  dehis- 
cence of  ova. 


Reproduction  is  only  possible  at 
certain  times  before  and  after  the 
menstrual  period. 


Reproduction,  at  no  time  im- 
perative, is  at  any  time  possible, 
though  more  probable  before  the 
menstrual  flow. 


The  menstrual  hemorrhage  is 
the  result  of  a  periodical  congestion 
of  the  uterus,  caused  by  the  irrita- 
tion of  rupturing  follicles  in  the 
ovaries,  and  entirely  subsidiary  in 
importance  to  the  ovarian  process.  By 
the  afflux  of  blood  to  the  great  net- 


The  menstrual  hemorrhage  is 
the  climax  of  a  series  of  processes 
carried  on  in  the  uterus,  quite  inde- 
pendently of  the  ovarian  budding. 
The  afflux  of  blood  to  the  uterus  is 
in  obedience  to  an  increased  nutri- 
tive demand  made  by  the  develop- 


IOO 


THE   QUESTION   OF   REST   FOR   WOMEN. 


work  of  vessels  surrounding  the 
uterus,  or  by  the  stasis  of  blood  in 
them,  the  tension  is  sufficiently  raised 
to  rupture  the  free  vessels  of  the 
endometrium,  so  that  hemorrhage 
occurs  as  in  epistaxis. 


ing  mucous  membrane,  which  con- 
stantly increases  in  thickness,  until 
it  has  reached  a  maximum  suitable 
for  the  retention  of  an  impregnated 
ovum.  The  hemorrhage  from  the 
uterus  is  the  result  of  fatty  degenera- 
tion and  desquamation  of  the  mu- 
cous membrane,  that  has  failed  to 
receive  the  stimulus  of  impregnation 
necessary  for  the  maintenance  of  its 
heightened  vitality.  By  this  des- 
quamation,  blood  vessels  are  laid 
bare,  and  the  resulting  hemorrhage 
is  strictly  analogous  to  that  after  the 
fall  of  the  decidua  in  parturition. 


The  vascular  tissues  of  the  uterus, 
ovaries,  and  broad  ligaments,  are 
species  of  erectile  tissues,  and  their 
periodical  turgescence  constitute  an 
erection  which  should  be  expected 
to  render  the  menstrual  period  an 
epoch  of  prolonged  sexual  excite- 
ment. 


The  helicine  arteries  and  bulbs 
of  the  uterus  and  ovaries  are  dis- 
positions for  pregnancy,  not  for 
menstruation.  There  is  no  proof 
that  these  tissues  are  ever  really 
urgescent  "  in  menstruation.  In 
normal  menstruation  the  circulation 
through  these  vessels  is  accelerated 
in  obedience  to  a  nutritive  demand 
on  the  mucous  surface  of  the  uterus, 
precisely  as  the  circulation  through 
the  muscular  coat  of  the  stomach 
and  intestines  is  accelerated  during 
digestion  in  obedience  to  an  in- 
creased nutritive  demand  upon  their 
mucous  surface.  But  if  an  accuimt- 
lation  of  blood  and  stasis  occur, 
abnormal  sensations  are  produced 
foreign  to  healthy  menstruation,  and 
indicating  that  some  modification 
of  the  healthy  process  has  occurred. 
All  the  processes  concerned  in  men- 
struation converge,  not  towards  the 
sexual  sphere,  but  the  nutritive,  or 
to  one  department  of  it — the  repro- 
ductive. 


ANALOGIES  BETWEEN  MENSTRUATION  AND  PARTURITION.  IOI 


The  periodicity  of  the  menstrual 
flow  constitutes  its  most  striking 
feature,  and  renders  this  process, 
peculiar  to  women,  an  extraordinary 
exception  among  physiological  phe- 


The  periodicity  of  the  menstrual 
flow  is  not  an  abrupt  interruption  of 
the  ordinary  physiological  life.  It  is 
the  simple  climax  of  a  series  of  con- 
secutive processes  perfectly  continu- 
ous with  one  another.  It  does  not  offer 
the  sudden  transition  of  the  func- 
tions of  animal  life,  but  the  gradual 
transitions  characteristic  of  the  func- 
tions of  vegetative  nutritive  life,  to 
which  indeed  it  belongs. 


The  writer  of  the  present  Essay  accepts  the  views  repre- 
sented by  the  second  of  the  above  columns.  But  it  may  be 
shown  that  the  explanation  of  the  monthly  hemorrhage 
there  given  cannot  be  considered  as  entirely  satisfactory. 
The  analogy  shown  between  the  menstrual  decidua  and  that 
of  pregnancy,  already  suggests  that  some  other  cause  for 
hemorrhage  must  exist  than  the  mere  desquamation  of  the 
mucous  membrane.  After  parturition,  many  other  condi- 
tions are  present.  The  walls  of  the  uterus,  full  of  blood,  are 
incessantly  retracting  and  squeezing  the  blood  out  of  those 
enormous  sinuses.  The  immense  accumulation  of  blood  in 
the  inter-ovarian  plexus  that  exists  at  this  moment,  furnishes 
abundant  source  for  the  hemorrhage.  But  at  menstruation 
a  hemorrhage  lasts  precisely  as  long  as  does  the  lochial  dis- 
charge, /.  e.,  the  sanguinolent,  without  the  existence  of  any 
such  local  accumulation.  According  to  Williams,  the  uterine 
parenchyma  was  found  pale,  and  although  other  observers, 
perhaps  somewhat  guided  by  their  expectations,  have  de- 
scribed a  general  hyperaemia  of  the  organ,  yet  there  is  con- 
fessedly nothing  comparable  with  the  turgescence  of  a  preg- 
nancy at  term.  Yet,  as  we  repeat,  the -menstrual  flow,  and 
the  sanguinolent  lochial  discharge,  are,  when  each  is  normal, 
almost  identical  in  duration  and  quantity.  It  is  the  men- 
strual flow,  however,  which  most  often  transcends  the  period 
of  four  days.  We  are  forced  to  conclude  that  the  blood 


102  THE  QUESTION   OF   REST   FOR   WOMEN 

comes  from  elsewhere  than  the  "  erectile  tissues  of  the 
pelvis  ;  "  that  the  local  process  in  the  endometrium  is  only 
the  starting  point  of  an  evacuation  which  is  really  drawn 
from  the  general  circulation.  For,  when  the  sanguinolent 
discharge  taking  place  from  the  uterus  after  parturition  has 
ceased,  the  organ  still  remains  very  much  larger,  and  the 
quantity  of  blood  contained  in  it  immensely  greater,  than  is 
the  case  in  any  menstruation.  On  the  other  hand,  excessive 
hemorrhage  in  menstruation,  though  often  connected  with 
hyperaemia,  dependent  on  sub-involution,  fungous  endome- 
tritis,  neoplasms,  etc.,  is  well  known  to  be  often  independent 
of  these,  and  connected  with  causes  affecting  the  general 
system — as  plethora  or  anemia  of  the  vascular  system,  or 
excitement  or  exhaustion  of  the  nervous.  A  physiological 
excess  of  blood  in  the  uterus,  therefore  (as  in  the  post  par- 
turn  state),  is  in  itself  insufficient  to  sustain  uterine  hemor- 
rhage, even  when  this  has  been  initiated  by  desquamation 
of  endometrium,  while  in  the  absence  of  local  accumula- 
tions of  blood  in  the  pelvis,  conditions  affecting  the  general 
nutrition  arc  capable  of  determining  the  most  exhausting 
hemorrhage. 

This  is  the  first  fact  which  indicates  that  the  menstrual 
flux  must  depend  upon  some  other  causes  than  the  local 
processes  going  on  in  the  uterus.  "  Were  the  hyperaemia 
the  direct  cause  of  the  hemorrhage,"  observes  Gusserow, 
"  extravasations  of  blood  would  be  found  much  more  fre- 
quently in  the  deeper  layers  of  the  Decidua  menstrualis."  ' 
Vicarious  menstruation  offers  an  entire  series  of  facts  show- 
ing, from  another  point  of  view,  that  the  cause  of  menstrua- 
tion .is  not  located  exclusively  in  the  uterus.  These  facts 
formerly  attracted  much  attention,  but  since  the  prevalence 
of  the  ovulation  theory  they  have  been  thrown  into  the  back- 
ground. Yet  all  such  cases,  of  which  Puech  has  collected 

Ueber  Menstruation  and  Dysmenorrhae.  Sammlung.  Klinike.  Yortrage 
\  olkmann. 


CARBONIC   ACID   AND   MENSTRUATION.  103 

two  hundred,  are  proof  positive  of  the  existence  in  the 
female  organism  of  a  necessity  for  the  periodical  evacuation 
of  a  few  ounces  of  blood, — necessity  so  profound,  that  if  the 
ordinary  mode  of  exit  be  barred  by  conge-nital  smallness  of 
the  uterine  blood  vessels,  or  defective  desquamation  of  the 
uterine  mucous  membrane,  the  evacuation  will  nevertheless 
be  effected  elsewhere.  In  only  one  case  did  Puech  find  a 
ruptured  vesicle  in  the  ovary  at-  the  time  of  the  vicarious 
hemorrhage.  In  the  form  of  chlorosis  described  by  Virchow, 
associated  with  congenital  smallness  of  the  blood  vessels, 
this  condition  is  not  confined  to  the  vessels  of  the  pelvis,  but 
is  generalized  throughout  the  body.  Here,  therefore,  the 
amenorrhea  is  uncompensated  by  any  wcarious  flux. 

We  do  not  propose,  in  this  place,  to  examine  the  various 
theories  that  have  been  advanced  in  the  most  remote  and 
the  most  modern  times,  to  explain  the  menstrual  flux  by 
some  necessity  of  purification,  or  of  elimination  from  the 
blood  of  morbific  material.  This  theory,  originally  derived 
from  the  Jewish  views  on  the  subject  of  uncleanness,  was 
supported  by  Aran  by  means  of  the  researches  of  Andral 
and  Gavarret  on  the  respiration.  These  physiologists,  as  is 
well  known,  asserted  that  during  menstrual  life  women 
habitually  exhaled  less  carbonic  acid  by  respiration  than  do 
men.  Aran  suggested  that  the  deficiency  was  made  good 
by  the  carbon  evacuated  with  the  menstrual  blood.  Dr. 
Clarke  rather  vaguely  admits  a  necessity  for  "  elimination  " 
of  sonietJdng,  as  one  for  which  special  provision  must  be 
made  during  the  time  of  menstruation.  The  reviewer  of 
Dr.  Clarke,  in  the  American  Journal  of  Medical  Science, 
enlarges  upon  the  same  idea. 

Rabuteau '  has  reexamined  these  experiments  of  Andral 
and  Gavarret,  and  affirms  that  in  them,  not  sufficient  atten- 
tion has  been  paid  to  the  time  in  relation  to  the  menstrual 
epoch.  That  during  the  period  comprised  between  the  five 

1  Gaz.  Hebd.  1870. 


104  THE   QUESTION   OF   REST    FOR   WOMEN. 

or  six  days  that  follow  the  cessation  of  menstruation,  and  a 
day  or  two  before  its  return,  the  elimination  of  carbonic  acid 
was  found  the  same  in  the  woman  experimented  upon  as  in 
man.  But  during  menstruation,  the  carbonic  acid  diminishes, 
because  from  the  loss  of  blood  corpuscles  the  amount  of 
oxygen  introduced  into  the  blood,  and  consequently  the 
organic  combustions,  are  diminished. 

The  temporary  diminution  in  the  elimination  of  carbon 
from  the  lungs,  while  indicating  a  temporary  diminution  in 
the  energy  of  respiration  and  in  the  nutritive  processes  of 
disassimilation,  is  very  far  from  indicating  an  accumulation 
of  carbonaceous  material  in  the  blood.  "  The  amount  of  COa 
extracted,"  says  Ranke,1  "  depends  upon  the  metamorphosis 
of  tissues.  It  is  increased  by  muscular  movement,  but  more 
so  by  any  increase  in  the  hydrocarbons  of  the  food,  and  in 
comparison  with  these,  all  other  circumstances,  as  age  and 
sex,  are  of  very  little  importance.  Part  of  the  CO.,  eliminated, 
passes  out  of  the  tissues  in  a  solid  state  in  saline  combinations 
in  which  the  venous  blood  is  richer  than  the  arterial."2  Ac- 
cording to  this,  either  venous  or  capillary  hemorrhage,  such 
as  constitutes  the  menstrual  flux,  would  compensate,  were  it 
necessary  a  defective  elimination  of  CO.,  by  the  lungs. 

It  does  not  therefore  follow,  however,  that  in  amenorrhea, 
unless  dependent,  as  is  exceptionally  the  case,  upon  a  local 
impediment  to  evacuation  by  the  uterus,  there  is  the  least 
danger  that  hydrocarbons  will  accumulate  in  the  blood.  For 
with  the  above  exception  amenorrhea  is  always  accompanied 
by  a  defective  nutrition  of  tissues,  lowered  vitality  of  cells, 
hence  a  diminution  in  the  absorption  of  Oxygen  and  corre- 
sponding diminution  in  the  formation  of  CO2 —  — "  The 
most  important  circumstance,  observes  Pfluger,  determining 
an  increased  absorption  of  O,  is  an  increased  vital  activity  in 
one  or  more  organs." 

The  condition  of  vital  activity  or  of  general  nutrition  that 

1  Grundzuge  der  Physiologic,  p.  465.  1875.  *  Ibid,  p.  471. 


NUTRITION   AND   MENSTRUATION. 


105 


obtains  during  the  menstrual  period  is  of  great  importance 
for  the  question  discussed  in  this  Essay. 

We  have  devoted  so  much  space  to  the  examination  of 
this  so  called  ovular  theory  of  menstruation,  because  it  has 
been  predominant  in  inducing  the  conviction,  that  during  the 
time  of  the  hemorrhagic  flow,  the  general  nutrition  and  vital 
activity  of  the  woman  must  be  lowered. 

This  view  has  not  been  universally  held,  nor  is  it  only 
held  by  the  advocates  of  the  ovulation  theory,  but  also  by 
those  whose  attention  is  especially  fixed  upon  the  fact  of  the 
periodical  hemorrhage.  Each  group  may  be  subdivided  into 
two  on  this  point,  according  to  the  different  interpretation 
given  to  the  same  facts.  Thus : 


During  menstruation,  nutrition 
and  nervo  muscular  action  must  be 
lowered. 


Or  on  the  other  hand  : 


1.  Because    the  local   processes 
effected  in  the  ovary  and  uterus  are 
so  complex,  and  involve  such  an  ex- 
penditure of  vascular,  nervous  and 
nutritive  force,  that  the  rest  of  the 
body  must  become  temporarily  bank- 
rupt. 

2.  Because  the  loss  of  blood  by 
the   catamenial   flow  acts  like   any 
other  hemorrhage  to  anemiate  the 
blood,  lower  the  tension  of  the  vas- 
cular   system,  and  by  the    loss  of 
blood  corpuscles  interfere  with  the 
absorption  of  oxygen,  with  formation 
of  CO.,,  and  of  urea,  in  a  word  with 
the  assimilafive   and  disassimilative 
processes  of  nutrition. 


The  menstrual  period  should  be 
one  of  increased  vital  energy. 


3.  Because  the  entering  upon 
active  functions  of  the  ovaries  im- 
plied by  the  rapid  maturing  and  de- 
hiscence  of  the  Graafian  vesicles 
affords  a  powerful  stimulus  to  the 
entire  nervous  system,  like  the  shock 
from  an  electric  battery : 


106  THE   QUESTION   OF    REST    FOR   WOMEN. 

4.  Because  the  hemorrhage 
which  when  restrained  to  normal 
proportions  is  not  followed  by  any 
of  the  consequences  of  accidental 
hemorrhage  implies  that  the  nutrition 
of  the  woman  has  reached  a  high 
maximum,  in  excess  of  her  individ- 
ual needs,  and  affording  a  surplus  of 
material  that  must  be  utilized  or 
thrown  away. 

Our  commentary  on  the  above  would  be  as  follows  : 

i.  The  increased  nutrition  of  the  ova  in  the  ovary  in  the 
cases,  far  from  universal,  where  this  coincides  with  men- 
struation and  the  increased  development  of  the  mucous 
membrane  of  the  uterus,  do  divert  from  the  general  circulation 
an  amount  of  blood  comparable  to  what  is  diverted  during 
the  functional  activity  of  many  other  organs.  Into  all  active 
organs  blood  streams  in  consequence  of  nerve  action,  and 
the  blood  current  is  accelerated. 

In  rabbits  at  rest  the  locomotive  apparatus  contains  36.6^ 
of  the  blood  mass;  but  in  rabbits  in  motion,  66^.  The  mass 
of  blood  in  any  organ  is  in  proportion  to  the  metamorphosis 
of  tissue  in  the  organ.  There  is  a  coincidence,  therefore,  of 
activity  and  hyperaemia  of  one  set  of  organs  with  repose  and 
anemia  of  another.1 

In  animals  killed  during  digestion,  the  entire  digestive 
apparatus  is  found  reddened  and  richly  injected  with  blood. 
The  stomach,  intestinal  mucous  membrane,  and  pancreas, 
show  this  change 'most  markedly:  the  liver  is  slightly  en- 
larged." "  There  is  such  an  opposition  between  the  circula- 
tion in  the  muscles  and  the  digestive,  that  we  are  enabled  to 
dissipate  congestions  of  the  liver  by  means  of  muscular 
exercise." 

I  am  not  aware  of  any  experiments  upon  women  anal- 
ogous to  those  made  by  Ranke  in  animals,  by  which  the 

1  Ranke,  Loc.  cit.  p.  374. 


LOCAL  ACCUMULATIONS  OF  BLOOD.         IO? 

amount  of  blood  circulating  in  the  uterus  and  ovaries  during 
menstruation  could  be  estimated.  For  reasotis  already  set 
forth,  neither  the  forced  injections  made  by  Rouget  on  the 
cadaver,  nor  the  intense  hyperaemia  observed  on  the  external 
genital  organs  of  animals  during  the  rut,  can  be  relied  upon 
as  a  basis  for  this  estimate.  But  the  size  of  the  organs, 
relative  to  the  mass  of  the  body,  indicates  that,  until  the 
beginning  of  pregnancy,  the  diversion  of  blood,  even  to  so 
rich  a  plexus  of  vessels  as  the  uteri-oyarian,  cannot  be  as 
extensive  as  to  the  liver,  gastro-intestinal  tract,  or  brain.  In 
rabbits,  Ranke  has  estimated  the  usual  distribution  of  blood 
thus: 

Spleen 0.23  per  cent,  of  the  whole  mass  of  blood. 


Brain  and  cord 1.24 

Kidneys 1.63 

Skin 2.10 

Intestines 6.30 


Bones 8.24 

Heart,  lungs,  great  vessels 22.76 

Muscles  in  repose 29.20 

Liver 29.30 


It  is  certain  that  the  amount  of  blood  determined  to  the 
pelvis  during  menstruation  (before  the  flow)  varies  extremely 
in  physiological  and  pathological  cases.  In  analyzing  pain- 
ful cases  we  shall  find  a  marked  contrast  between  the  cases 
where  no  pain  is  experienced,  or  where  it  only  comes  on  in 
the  shape  of  cramps  during  the  first  day  or  two  of  the 
hemorrhage,  and  those  other  cases  where  the  flow  is  pre- 
ceded for  several  days  by  sensations  of  weight,  dragging, 
fullness  about  the  loins,  indicative  of  pelvis  congestion. 

We  shall  have  occasion  to  speak  of  these  cases  again.  It 
suffices  here  to  insist  on  the  fact,  that  as  they  differ,  to  how- 
ever slight  a  degree,  from  perfectly  healthy  cases,  they  can- 
not be  considered  to  illustrate  the  type ;  and  that  wherever 
the  sensation  of  weight  is  absent,  trifling,  or  only  just  pre- 
cedes the  flow  that  relieves  it,  we  may  affirm  that  the  pelvis 
blood  vessels  have  not  been  distended  by  an  amount  of  blood 
sufficiently  considerable  to  seriously  deplete  the  rest  of  the 
system. 


IO8  THE   QUESTION   OF    REST   FOR   WOMEN. 

The  appearance  of  the  mucous  membrane  during  men- 
struation has  been  frequently  compared  with  that  offered  by 
others  in  acute  catarrhal  inflammation  (Courty,  Beigel,  Vir- 
cho\v,  etc.).  The  term  suggests  a  pathological  condition, 
which,  however,  lies  in  the  term.  If,  as  is  certainly  true  (see 
our  statistics),  this  process  can  be  accomplished  in  53  per 
cent,  of  cases  without  the  least  interference  with  the  con- 
sciousness of  well  being,  it  is  evident  that  the  resemblance 
with  inflammation  is  deceptive,  since  quite  a  slight  degree 
of  inflammation  of  this  same  membrane  always  involves  dis- 
tinct suffering.  Expenditure  of  nervous  or  formative  force 
involved  in  the  rupture  of  follicles  and  growth  of  the  decidua, 
ceases  to  appear  a  brusque  robbery  from  the  sum  total  of 
the  individual  force,  when  these  processes  are  seen  to  be  so 
gradual  in  their  evolution.  Although  only  one  Graafian  fol- 
licle (in  the  human  subject)  be  ever  ready  to  rupture  at  any 
given  time,  yet  it  is  admitted  on  all  sides  that  the  develop- 
ment of  different  follicles  at  various  grades  is  incessant.  Still 
more  gradual  (if  possible)  has  been  shown  to  be  the  growth 
of  the  endometrium,  which  is  scarcely  inactive  during  eight 
or  ten  days,  if  at  all.  Nor  are  these  days  those,  except  in 
persons  affected  with  endometritis,  on  which  the  woman 
habitually  feels  in  the  best  health,  for  that  is  during 
the  week  immediately  preceding  menstruation,  when  the 
tumefaction  and  injection  of  the  membrane  reach  their 
height. 

It  is  true  therefore  that  the  vital  activity  of  the  cells  of 
the  ovary  and  uterus  proves  the  necessity  for  an  amount  of 
vital  force  in  the  organism  superior  to  what  would  be  required 
by  an  individual  having  no  corresponding  organs. 

But  as  this  demand  for  vital  force  is,  as  we  have  shown, 
continuous,  it  implies  a  permanent  provision  for  its  existence 
in  the  organism,  and  not  a  succession  of  temporary  revolu- 
tions of  that  organism's  resources.  A  body  more  rich  in 
organs,  an  organ  more  rich  in  cells,  consumes  absolutely 


MENSTRUATION   AND   VITAL   ENERGY.  ICQ 

more  material  than  one  poorer  in  organs,  (Ranke  Loc.  cit.  p. 
19.)     In  other  words,  it  is  constructed  on  a  higher  type. 

2.  The  best  commentary  to  be  made  upon  this  statement, 
is  the  counter  statement  under  the  fourth  head,  showing  that 
the  menstrual  flux  does  not  resemble  in  its  phenomena  or  in 
its  effects  any  accidental  hemorrhage. 

3.  We  have  a  certain  number  of  facts  to  be  related  further 
on,  which   indicate  that  the  period  of  menstruation  may  be 
one  of  increased  vital    energy  and    especially  of  increased 
mental  force.     But  we  cannot  find   in  the  ripening  of  the 
Graafian  follicles,  any  cause  for  an  increased  stimulus  to  the 
nervous  system. 

It  is  the  presumed  analogy  between  menstruation  and  the 
rut,  and  the  theory  that  the  starting  point  of  the  whole 
menstrual  nisus  was  to  be  found  in  the  bursting  of  this  tiny 
vesicle,1  that  has  theoretically  invested  a  nutritive  process,  so 
minute  in  extent,  however  mighty  in  result,  with  such  an 
immense  influence  on  the  nervous  system.  The  peritoneal 
wound  (shown  by  Waldeyer  not  to  exist,  since  the  peritoneum 
does  not  cover  this  portion  of  the  ovary,)  which  excited  such 
luxuriant  compassion  on  the  part  of  Michelet,  should  by  this 
time  be  relieved  of  the  responsibilities  laid  upon  it.  We 
think  indeed  that  the  female  economy  can  be  shown  to  nor- 
mally experience  a  stimulus,  more  or  less  powerful  in  con- 
nection with  menstruation,  but  there  is  nothing  to  show  that 
this  is  derived  from  a  sudden  and  fermentative  evolution  of 
nerve  force  in  the  ovaries.* 

1 "  All  facts  agree  to  prove  that  menstruation  is  the  consequence  o'f  the  ovarian 
process  on  which  depends  the  development  and  rupture  of  the  Graafian  vesicle. 
The  menstrual  hemorrhage  is  an  accident  due  to  the  insufficient  resistance  of  the 
capillaries  of  the  endometrium,  when  congested  at  the  time  of  the  development 
of  an  ovarian  vesicle."  Liegois,  Trait£  de  Physiologic.  1869.  Pp.  262-264. 

*  Chereau,  Maladies  des  ovaries. 

The  extent  to  which  the  ovaries  have  succeeded  to  the  uterus,  in  the  capacity 
for  inflaming  the  scientific  imagination,  may  be  gathered  from  these  words  of 
Virchow.  "  The  woman  is  only  woman  on  account  of  her  generative  glands  " 


1 10  THE   QUESTION   OF   REST    FOR   WOMEN. 

4.  These  remarkable  peculiarities  of  the  menstrual  flow, 
which  to  the  majority,  of  observers  learned  or  simple,  have 
always  distinguished  it  from  accidental  hemorrhage,  demand 
an  explanation  if  any  theoretical  conclusion  can  be  arrived  at 
in  regard  to  the  effect  of  menstruation  on  the  working  capa- 
city of  women.  It  is  certain  that  in  the  case  of  any  other 
hemorrhage  of  far  less  amount  and  duration,  the  most  com- 
plete rest  of  body  and  mind  would  be  claimed  as  a  matter  of 
course.  It  would  not  be  necessary  for  instance,  to  forbid 
peasant  women  from  treading  out  grapes  in  a  wine  vat,  dur- 
ing an  attack  of  epistaxis,  as  it  has  been  found  necessary  to 
do  during  menstruation,  not  for  the  sake  of  hygiene  but 
cleanliness.  Their  own  bodily  discomfort  would  suffice  to 
preserve  the  proprieties. 

If  of  the  two  modern  theories,  periodical  or  reflex  irrita- 
tion from  the  ovaries,  or  fatty  degeneration  of  a  uterine 
decidua  rendered  useless  by  the  failure  of  conception,  neither 
serves  to  completely  explain  the  menstrual  hemorrhage,  we 

(ovaries).  All  the  peculiarities  of  her  body  and  mind,  of  her  nutrition  and  nerve 
activity,  the  sweet  delicacy  and  round  contour  of  her  limbs,  the  characteristic 
shape  of  her  pelvis,  the  development  of  her  bosom,  the  gentleness  of  her  voice, 
the  beautiful  lustre  of  her  hair,  and  the  scarcely  perceptible  down  on  her  cheeks  ; 
then  again,  the  depth  of  feeling,  devotion  and  fidelity,  in  short  all  the  feminine 
qualities  that  we  admire  and  honor  in  the  true  woman,  are  only  a  consequence  of 
the  ovary.  What  wonder  then  if  by  the  periodical  clehiscence  of  ova,  phenomena 
occur  which  indicate  the  general  participation  of  nutrition  and  nerve  force  ?  I 
will  remind  the  practical  physician  of  teething,  a  process  which  consists  in  the 
periodical  reproduction  of  parts  of  much  less  significance,  and  which  neverthe- 
less is  accompanied  with  the  liveliest  disturbance  of  nutrition  and  nerve  force. 
(Her  puerperale  Zustand.  Das  Weib,  and  Die  Zelle,  1848.  P.  751.) 

We  think  in  regard  to  this  language,  the  remark  of  Puech,  who  comments 
upon  it,  is  justified:  "Certainly  if  brilliancy  of  thought,  if  elevation  of  language 
occupied  the  place  of  arguments,  we  must  incline  before  this  panegyric,  but  in 
physiology  as  in  medicine,  the  authority  of  the  master  is  dominated  by  the 
authority  of  facts.  In  view  of  the  observations  related  in  this  chapter,  [showing 
the  persistence  of  feminine  qualities  in  the  absence  or  after  the  extirpation  of 
the  ovaries;]  the  idea  of  Virchow  regarding  their  role  is  not  only  gratuitous,  it 
is  illogical."  Des  ovaries,  de  leurs  anomalies,  1873,  p.  125. 


PLETHORIC   THEORY   OF   MENSTRUATION.  Ill 

are  led  back  to  the  older  theory,  which  has  prevailed  half  as 
many  centuries  as  the  ovulation  theory  has  years,  the  theory, 
namely,  of  an  excess  in  women  of  nutritive  force  and  mate- 
rial, which,  when  not  utilized  in  reproduction,  is  expended 
in  menstruation.  Wagner,  whom  we  have  already  quoted  as 
a  champion  of  the  ovulation  theory,  /'.  e.,  as  considering  "  the 
characteristic  cause  of  menstruation  to  reside  in  the  ovaries," 
adds,  "  Nevertheless,  we  are  far  from  contesting  a  special 
physiological  significance  to  this  hemorrhage.  .  .  .  The 
blood  which  is  evacuated  at  the  time  of  menstruation  contains 
all  the  essential  constituents  of  normal  blood.  .  .  .  What- 
ever peculiarities  it  offers  are  explained  by  the  external  con- 
dition of  its  evacuation.  We  should  therefore  with  difficulty 
be  justified  in  considering  the  menstrual  blood  as  useless 
material.  It  is  a  surplus  acquired  in  the  mechanism  of  indi- 
vidual life,  and  whose  formation  is  effected  by  the  entire 
mechanism  of  the  body.  It  is  completely  analogous  to  the 
formative  material  which  elsewhere  is  employed  for  the 
development  of  the  embryo,  for  the  nutrition  of  the  egg.  etc. 
The  surplus,  which  could  with  impunity  be  removed  from 
the  individual  existence,  which  indeed  must  be  removed 
under  penalty  of  manifold  disturbances,  serves  to  cover  in- 
creased expenditures.  .  .  .  According  to  our  opinion, 
the  separation  of  the  menstrual  blood  is  nothing  else  than 
the  separation  of  a  superfluous  formative  material  in  a  char- 
acteristic form.  What  in  other  cases  (/.  e.  in  oviparous 
animals)  leaves  the  material  body  as  the  substance  of  the 
ovum,  here  passes  away  as  blood,  in  the  same  form  in  which 
it  originally  is  brought  to  the  ovum. 

On  this  account  is  the  menstrual  flux  limited  to  the 
mammiferae.  For  in  these  animals  the  ovum  is  so  small  that 
after  its  formation  a  large  amount  of  formative  material  is 
left  over.  Again,  were  the  mammiferae  egg-laying  animals 
like  birds,  then  doubtless  must  the  egg  contain  all  the  nutri- 
ment required  by  the  embryo.  Thus,  in  a  human  being,  the 


112  THE   QUESTION   OF   REST    FOR   WOMEN. 

e<T<_r  must  contain  as  much  nutriment  as  is  absorbed  from  the 
maternal  body  during  ten  months'  gestation.  In  that  case, 
an  egg  could  only  ripen  every  ten  months,  and  the  possibil- 
ities of  conception  would  therefore  be  extremely  limited. 
But  in  fact,  the  material  which  we  have  imagined  concen- 
trated upon  a  single  rut,  is  divided  over  ten  successive 
periods  of  rutting,  at  each  of  which  conception  is  possible. 
The  striking  minuteness  of  the  mammalian  ovum,  therefore, 
may  be  considered  as  a  means  whereby  the  possibilities  of 
fecundation  are  multiplied,  and  thus  indirectly,  the  fertility 
of  the  mammiferai  heightened." 

Reproduction,  without  a  previous  provision  of  reproduc- 
tive material  and  of  formative  force,  is  unknown  throughout 
the  vegetable  and  animal  kingdom,  and  is  indeed  inconceiva- 
ble. In  plants,  nutritive  material  accumulates  regularly  at  the 
nodes  of  the  stems,  and  the  degree  of  development  attained 
by  the  bud  springing  from  the  nodes,  is  proportioned  to 
the  space  between  them  or  the  internodes.  So  has  Wagner 
again  shown  that  the  number  of  offspring  of  any  race  of 
animals  is  in  exactly  inverse  proportion  to  the  weight  of  off- 
spring at  a  birth,  and  this  proportioned  to  the  length  of 
gestation.  "  Genesis,  under  every  form,"  says  Herbert  Spen- 
cer,1 "  is  a  process  of  negative  or  positive  disintegration,  and 
is  thus  essentially  opposed  to  that  process  of  integration 
which  is  one  element  of  individual  evolution.  Negative  dis- 
integration occurs  in  those  cases  where,  as  among  the  com- 
pound Hydrozoa,  there  is  a  continuous  development  of  new 
individuals  by  budding  from  the  bodLs  of  older  individuals  ; 
and  where  the  older  individuals  are  thus  prevented  from 
growing  to  a  greater  size.  Positive  disintegration  occurs  in 
those  cases  of  agamogenesis  where  the  formation  of  new 
individuals  is  discontinuous ;  and  in  all  cases  of  gamo- 
gencsis.  .  .  .  The  degree  of  disintegration  becomes  less 
marked  as  we  approach  the  higher  organic  forms.  Among 

1   Principles  of  Biology,  Vol.  I.,  p.  216. 


GENERATION   AND   INDIVIDUAL   NUTRITION.  113 

the  higher  animals  there  is  no  case  in  which  the  parent  indi- 
viduality is  habitually  lost  in  the  production  of  new  individ- 
ualities. To  the  last,  however,  there  is  of  necessity  a  greater 
or  less  disintegration.  The  seeds  and  pollen  grains  of  a 
flowering  plant  are  disintegrated  portions  of  tissue,  as  are 
also  the  ova  and  spermatozoa  of  animals."  Again  (p.  224), 
"  Agamogenesis  continues  so  long  as  the  forces  which  result 
in  growth  are  greatly  in  excess  of  the  antagonistic  forces, 
while  conversely,  we  find  that  the  recurrence  of  gamogenesis 
takes  place  when  the  conditions  are  no  longer  so  favorable 
to  growth.  .  .  .  Very  high  nutrition  in  plants  prevents 
or  arrests  gamogenesis."  De  Candolle  says,1  "  The  indefinite 
development  of  boughs  which  do  not  flower,  favors  the  birth 
and  growth  of  a  great  number  of  nutritive  leaves,  which 
tend  to  increase  the  aggregate,  and  to  deposit  here  and  there 
stores  of  nourishment  suited  to  favor  new  development  of 
germs  or  flowers.  The  termination  in  flowers  tends  to 
deprive  branches  of  the  development  of  nutritive  organs,  and 
to  consume  the  nourishment  stored  up  in  the  branches, 
stems,  or  roots.  In  caulocarpal  plants,  the  flower  is  small, 
and  only  consumes  the  nourishment  stored  in  its  own 
peduncle  and  immediate  supports.  These  are  perennial 
plants,  trees,  and  shrubs.  In  rhizocarpals  the  flowers  are 
more  numerous,  in  proportion  to  the  strength  of  the  stem, 
and  exhaust  all  its  nourishment,  so  that  it  dies  down  to  the 
root.  These  are  perennial  herbs.  In  manocarpals,  the  flow- 
ers are  still  more  numerous,  and  exhaust  the  root  as  well  as 
the  stem.  These  are  annual  or  bisannual  plants."  Darwin 2 
says  of  sterile  cultivated  plants,  with  double  flowers,  rich 
seedless  fruit  with  largely  developed  organs  of  vegetation, 
that  there  is  in  them  a  saving  of  nutriment  and  vital  force, 
"  because  the  sexual  organs  do  not  act,  or  act  imperfectly.  In 
his  treatise  on  sexual  selections,  passim,  the  author  insists 

1  Organographie  Vegetale,  1827,  p.  230. 

*  Variations  of  Animals  under  Domesticity,  Vol.  II.,  pp.  131,  172. 
8 


114  THE   QUESTION   OF   REST    FOR   WOMEN. 

on  the  secondary  sexual  characters  of  brilliant  plumage  and 
various  appendages  in  the  male  of  various  animals,  especially 
birds,  that  seem  to  serve  as  an  equipoise  to  the  excess  of 
reproductive  force  in  the  female.1 

1  A.  B.  Blackwell  (Sexes  throughout  Nature)  has  justly  pointed  out  that  these 
secondary  sexual  characters  are  much  more  strongly  marked  in  polygamic  birds, 
and  where  food  is  easily  accessible,  so  that  the  male  is  not  compelled  to 
himself  even  for  the  indirect  nutrition  of  offspring. 


exert 


SECTION   IV. 

EXPERIMENTAL. 

ON  the  hypothesis  that  the  menstrual  period  represents 
the  climax  in  the  development  of  a  surplus  of  nutritive 
force  and  material,  we  should  expect  to  find  a  rhythmic 
wave  of  nutrition  gradually  rising  from  a  minimum  point 
just  after  menstruation,  to  a  maximum  just  before  the  next 
flow. 

The  traces  of  this  rhythmic  wave  should  be  measured  by 
the  consumption  of  oxygen,  the  excretion  of  CO,j  and  of 
urea,  by  the  tension  of  the  arterial  system,  the  vital  capacity 
of  the  lungs,  possibly  also  by  the  dynamic  force  of  muscles. 
We  have  attempted  to  make  a  few  of  these  measurements. 
The  following  tables  show  the  results  of  daily  measurements 
of  urea  in  the  urine  of  six  persons  for  a  period  of  one,  two, 
or  three  months. 

The  urea  was  measured  by  Liebig's  volumetric  method. 
The  whole  quantity  of  urine  passed  in  twenty-four  hours  was 
collected,  and  the  specimen  analyzed  was  selected  from  the 
whole  amount. 


Il6  THE    QUESTION    OF    REST    FOR   WOMEN. 


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TABLE   NO.    I. 


117 


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US  THE   QUESTION   OF    REST    FOR   WOMEN. 


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TABLE   NO.   II. 


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s 


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coOWcn^J-O^t'CI 
f.    cncncncocococo 


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N       COCOCOM       COCO-COCOCO- 


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T20  THE    QUESTION    OF    REST    FOR    WOMEN. 


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5     "  3    fo  £  fo 


TABLE   NO.   II. 


121 


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s|s 


*&%$ 


^ 

CO  CO 

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*      ?      -      *  g; 

cn^icn^-        c^c^cncnc^cncncn'-*        en       * 
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co~        coicocococo*       cocococo"        co^          I 

•  '••»"•"•  - 1=  •  •  " 


122 


THE   QUESTION   OF   REST   FOR   WOMEN. 


NO.  III. 

A.    M. 

Date  '75 

Pulse. 

7           Temperature.            n 

Dynamics. 

Pu  se. 

7 
j'clk 

ii 

o'clk 

Mouth. 

Axilla. 

Vagina. 

Rectum. 

Right. 

Left. 

4  O'clk. 

no'clk. 

tine  19 

72 

73 

99-2 

98.7 

TOO. 

IOO.I 

74 

67 

"      20 

66 

98.9 

98. 

99.8 

99-8 

68 

93.5 

97-9 

99. 

99.1 

"      21 

74 

76 

98.6 

98. 

99-5 

99-5 

82 

98.4 

93-3 

99- 

99- 

"      22* 

63 

74 

99-2 

98. 

99-3 

251 

25 

65 

98.4 

98. 

gljf 

93-7i 

"     23* 

65 

63 

99- 

93.5 

99-2  i 

99-2£ 

26 

261 

70 

64 

93-3 

98. 

98.5 

98.6 

«     24* 

72 

73 

99- 

98.4 

99.6 

99.6 

281 

29 

94 

71 

93-5 

98.1 

98.6 

98.7 

"   25 

72 

70 

99.2!!  98.7! 

99.2.1 

99-4 

2/1 

2Si 

74 

70  • 

98.2^ 

98. 

93.3" 

98.5 

"    26 

70 

76 

99-2 

98.4 

99-5 

99-5 

301 

34 

76 

68 

98.4 

98. 

98.6 

98.8 

"    27 

68 

70 

76 

7° 

98.1    j   98. 

93-5 

98.6 

"    28 

66 

72 

74 

7O 

98.2 

97.8 

93-5 

98-5 

"   29 

64 

70 

66 

98.4 

'98.'" 

9s-5 

98.6 

"  30 

60 

7° 

99-21 

98.9 

98.8 

99-3 

281 

28 

80 

78 

98.1 

97-3 

99. 

99.1 

uly     I 

84 

92 

98.9 

99-5 

31 

30 

86 

62 

98.5 

97-3 

gS.6 

98.6 

"        2 

62 

70 

93-71 

99-71 

99- 

31 

29 

78 

66 

93-5 

98.  2\ 

98.7! 

98.7! 

3 

66 

76 

93.2|- 

980" 

99-5 

99.1 

34 

3°| 

80 

60 

"      4 

62 

84 

98.4 
99- 

98. 

93.9 

93-7?T 
99-71 

98.6 
99-3 

30 

30 

84 

64 

98.5 

9S.2| 

98.6 

99- 

"      5 

64 

72 

99-5 

93.8 

99-5 

99.6 

32 

30 

80 

62 

"      6 

62 

So 

93-5 
99-5 

98. 

99- 

99.1 
99-7s 

99.1 
99-3 

82 

66 

98.5 

93. 

99- 

99- 

"      7 

63 

34 

29 

64 

gs.5 

98.2 

99- 

99-2 

8 

66 

72 

99-5 

99-2 

99-9 

99-71 

34i 

29 

76 

74 

99- 

98.8 

99-21 

99-2  1 

9 

7° 

30 

28 

90 

"      10 

88     1 

"    ii 

80 

99- 
82   i  99.1 

93-3 
99.1 

99-5 
99-21 

99.6 
99-  b 

32 

3° 

88 

OO        | 

74 

"      12 

"  13 

62 
66 

84 

7° 

95.4 
99- 
98.6 
99-21 
98.4 

98.2 
98.9 

93.4 

99-3 
98.1 

98.6 
99-7. 
99-2 
99.6 
99-2^ 

99- 
99-3 
99-3 
99.6 
99-3 

32 
33l 

30 
30 

72 

66 

1 

33 

3° 

86 

70 

"  15*1  76 

i  99- 
76  i  99.2' 

98.5 
98.4 

99.1 
99.4 

99- 
99.6 

35 

29 

84 

66 

TABLE   NO.  III. 


123 


NO.    III. 


7           Temperature.           n 

Dynamics. 

Grms. 
Urine. 

Grms. 
Urea. 

Per 
Ct. 

Remarks. 

Mouth. 

Axilla. 

Vagina. 

Rectum. 

Right. 

Left 

98.8 

98.4 

99-7 

99-5 

Sick  Headache. 
Mens.  this  morn 
Some    pain    of 
steady  charactei 
Mens.  flowslight 
Mens.  flow  just 
noticeable.  Con- 
gestive head- 
ache from  over- 
heating. 
Went  to  country 
in  P.  M. 

Returned  this  A. 

M. 

Headache. 
Studied  late. 

Mens. 

98-7i 

98.2^ 

99. 

99. 

98.6 

98.2. 

99.4 

99-5 

2S£ 

28^ 

30 

3oi 
30 

27i 
28| 
30 
30| 
30 

98.2 
99-4 
98.4 
99- 
98.5 
99-3 
99- 
99-4 
98.4 
99.1 
984 
99- 
98.5 
99.6 
98.4 
99-4 
98.4 

% 

99.1 
98.4 

98.7* 
98. 

99-5 
98.5 
99.1 
98.9 
99-5 
99- 

98.1 
98.6 
98. 
98.4 

98.2! 

98.5 
98.4 

98.8 

98.. 

98.6 

98. 

98.8 
98.3 
98.6 

98. 

99. 

97-8 
98.4 

97-9 
9&.6 
98. 

98-5 
98. 
98.6 
98.2^ 
98.9 
98.2^ 
98-8^ 
98.5 

98.8 
99.4 
98.6 
99-5 
98-7i 
99.6 
99.1 
99.6 
98.6 

99- 
99. 

99-5 
98.8 
99-3 
98-7i 
99-7? 
98.5 
99-4 
99-4 
99-2i 
98.2^ 
99-2^ 
98.1* 
999 
98-7i 
99-5 
99- 
99-9 
99.1 

98.8 
99-4 
98.6 
99-7 
99- 
99-7 
99-2i 
99.8 
98.7 
99-2 
99.1 
99-5 
98.8 
99-5 
98-7i 
99-7i 
98.6 
99.6 
99-4 

99.2* 

98.4 

99-H 
98.2^ 
99.9 
99.6 
99-5 
99- 

IOO. 

99-2| 

886.41 
1123.692 

16.227 
28.092 

IA% 

2& 

3& 

886.41 

29.251 

29i 

30 

35 
32 
37 
35i 
37 
35 

28^ 

30 
30 
31 
32 

3i| 
34 
30 

1211.427 

26.651 

2iV 

1418.256 
1419.162 

3L9IO 
36.896 

2T8A 
2lV 

9I5-957 

25.188 

2TV50 

Il8l.88o 

3L9IO 

*A 

98.5 

98.3 

99- 

99- 

98.5 
99.6 

98.2i 

99.4 

99. 

IOO.I 

99.1 
100.3 

35 
32 

3i 

3i* 
30 
29 

137.559 
063.692 

25-595 
27.655 

2l8A 
2A°ff 
2l8A 

99-  7  i 
98.4 

99-5 

98. 

100. 

98.6J 

100.3 
98-5J 

33 
40 
34 

3i 
33 
30 

152.333 

28.808 

98-3J 
99-5 
98.3 
98.3 
98.5 

97-9 
99- 
98.4 
98.5 
98. 

98.6 
99.9 
99-2 

100. 

99-5 

98.^ 
99.8 
99-5 

IOO. 

99.6 

945.504 

31.674 

3T8A 

124 


THE   QUESTION   OF   REST   FOR   WOMEN. 


NO.   III.     (Continued^ 

A.    M. 


Date  '75 

7            Temperature.            n 

Dynamics. 

Pulse. 

o'clk 

./elk 

Mouth 

Axilla. 

Vagina 

Rectum 

Right. 

Left. 

4  o'clk 

no-elk. 

98.4 

98. 

98.6 

98.7! 

July   16* 

63 

76 

99.1 

99.  2  -J 

99-2l 

32* 

29 

tS 

98.2! 

98. 

98.5 

98.6 

"     17* 

66 

74 

99- 

98.4 

99- 

99- 

33 

29 

98 

66 

95-4 

98. 

956 

99. 

"     iS 

68 

74 

99- 

98.6 

99-9 

99-9 

38^ 

30 

96 

60 

"     19 

64 

So 

98.2^ 
93.7i 

97-71 
9s-3 

98.4 
99-2 

93.3 
99-2 

32 

23 

78 

60 

"      20 

6S 

So 

98.7, 

93.71 

99-5 

'99.6" 

32 

261 

98 

62 

98. 

q-;  -.JL 

98-5 

98.6 

"      21 

60 

64 

98.7! 

98.5 

99-21 

99-2 

35 

30 

So 

68 

.<      22 

64 

66 

98.8 

98.4 

'99.4 

99-21 

34 

23 

82 

74 

"      23 

86 

99-3 

99- 

'99.6' 

99-8 

341 

26 

74 

60 

98.5 

97-8 

98.5 

98.5 

"      24 

63 

35 

32 

64 

"      25 

76 

99- 

98.6 

99-71 

roo. 

34 

28 

74 

66 

98.5 

98. 

99- 

99- 

"      26 

7° 

86 

99.1 

98.3 

99-5 

99.6 

30 

28 

78 

74 

93.5 

97-9 

98.7.1 

98.8 

27 

66 

74 

99-2 

99- 

99.6" 

99-9 

33 

28 

78 

70 

"      23 

76 

99.2 

98.7! 

1  00.  1 

100. 

33 

28 

80 

63 

95.6 

98.2 

99-2 

99-21 

29 

72 

82 

99-21 

98.9 

99-5 

99-5 

32. 

27 

82 

74 

''      30 

-• 

So 

99-5 

99- 

996 

99.3  '  ' 

30 

26! 

74 

60 

"      31 

66 

•• 

99-2       98.71 

99-4 

99-2 

35 

27 

So 

Aug.    i 

76 

99-4       99- 
99-2       98.5 

100.4 
99-71 

99-  7  1 

36 

30J 

So 

66 

"         2 

72 

33 

29 

66 

66 

"       3 

63 

' 

9S-5       98.5 

99-6  :  98.3 

99-5 
99.6 

99.6 
99-71 

30 

29 

86 

76 

ya.a        93. 

99-3 

99-3 

"      4 

74 

80  j   99-4       99-2 

OJ. 

oo. 

32 

3° 

So 

64 

"      5 

66 

98.6     98.2.1 

99- 

99-21 

f.  . 

"      6 

62 

72 

98.8 

99-2 

98-2^ 
98.6 

99- 
99.6 

99.1 
99.6 

34 

72 
72 

°4 
64 

"      7*    70 
"       S*    60 

72 

99- 
99-  2  J 
99-8 
99- 

98-5 
99. 

934 

99-2  1 
99.6 
99- 
99-5 

99-21 
99- 
99-4 

99-5 

34 

30 
3° 

70 

63 
62 

"       9* 
"    10 

66 
62 

76 
78 

93.5 
99-2| 

99-4" 

98-2! 
gS.8 
93. 
99- 

99- 
99-71 
99-2£ 
99-5 

99-i 
99-8 
99-21 
99-5 

34 

29 

72 
70 

64 
66 

TABLE   NO.  III. 
NO.    III. 


125 


7           Temperature.           n 

Dynat 

nics. 
Left 

Grins. 
Urine. 

Grms. 
Urea. 

Per 
Ct. 

Remarks. 

Mouth 

Axilla. 

Vagina. 

Rectum 

Right. 

99-3 
98.4 
99-5 
98-7i 
99-4 
98-2^ 
99. 
98.2' 
99-5 
98. 
99-2i 
98.6 
99-21 
98.5 
99-4 
98. 

99.1 
98. 
98.5 
98. 
98.4 
97-5 
98.6* 
97-5 
98.7£ 
98. 
98.7J 
98.3 
9S.6» 
98.2J 
98.9 
98. 

99-5 
99. 
98.8 
98.5 
99. 
98.1 
99-3 
98.1 
99-5 
98.5 
99-5 
99- 
99-5 
98.5 
99-5 
98.5 

99-5 
99- 

100.2 
98.5 
99. 
99.1 
99.6 
98.4 
99-5 
98.4 

99-  5  1 
99- 
99-71 
98.5 
99-4 
98.5 

37 
35 
35 
35 
34 
.    36. 
36 
34 
33 

30 
30 
31 
29 

28 
32 
32 
26 
29 

590.940 
I226.2OO 
590.940 
753-448 

19.796 
26.363 
16.250 
24.110 

3iV0 

2l1o60 
2l7A 

31% 

Headache. 

Slept  very  little. 
At  work  men- 
tally anxious. 

Constipated. 
Constipated. 
Cold  and  rainy. 

Metis,  this  even- 
ing, no  pain  to 
notice. 

9I5-957 
1048.918 

25.188 
30.418 

2TVB0 
2l°0°T7 

98.5 
99-2  1 
98.2] 

99-5 
98.9 

97-9 
99.1 
93. 

98.21 

98.5 
99.9 
98.5 

100. 

99.1 

98.6i 
99.9 
98.6 

IOO. 

99-21 

975.051 

23401 

2TV* 

1181.880 

22-455 

IT?* 

99-5 
98.5 

98-3 

99-9 
99.1 

99.6^ 
99-2  i 

34 

29 

1004.598 

25.114 

2T6D°0 

36 

3?i 

99- 

98.5 

99- 

99- 

521.670 

33-476 

**ft 

36 
39 
38 
341 
36| 

33 
33 
35 

30 

35 
30 
3iJ 
3i| 

29! 
29 
3iJ 

99.21 
99-2^ 
98-7 
99-51 
98.4 

IOO.I 

98.7 
99-5 
99 
99-6 
98.9 
99-5 
98.8 

98.8 
99- 
98.5'J 
99-4 
98. 
99-2 
98. 
99- 
98.3 
99- 
98.5 
98.8 
98.5 

99-7 

100. 

9S-7J 
99-7| 
98.7i 

100.21 

99-2 
99-7| 
99-3 
too. 
99. 
99-7i 
99. 

IOO. 
IOO. 

99- 
99.8 
98.8| 
100.3 
99-2| 
99-9 
99-2 

IOO. 

99-  1  1 
99-9 
98.9 

100.625 

25.864 

2A60 

248.360 

26.839 

21^ 

034.145 

226.200 
011.984 

25.853 

28.815 
24-793 

2T&* 

2l'A 
2l4A 

98. 
99- 

98. 
98-5 

98.5 
99-2| 

98.5 
99-2  1 

126 


THE   QUESTION   OF   REST    FOR   WOMEN. 


NO.  III.     (Continued^ 

A.    M. 


Pll 

se. 

7 

Temp 

jrature. 

" 

Dyna 

mics. 

Pu 

se. 

Date  '75 

7 
o'clk 

o'clk 

Mouth 

Axilla. 

Vagina 

Rectum 

Right. 

Left. 

4  o'clk 

no-elk. 

Aug.  II 

"0 

99-3 

9S.7i 

99-5 

99-5  i 

30 

26 

S6 

66 

"           JO 

80 

64 

64 

J 

/- 

"   14 

63 

9s-5 

98. 

99- 

99- 

70 

63 

"   15 

70 

99-4 

99- 

TOO. 

TOO.  I 

32 

27 

63 

"  If) 

33  i 

30 

So 

63 

"    l~ 

74 

93.V| 

'98-5" 

99.2  J 

99-21' 

32 

2S 

70 

98-3 

93.5 

"    18 

66 

§4 

99-4 

99-5 

32 

29 

32 

70 

93. 

98.4 

"     19 

66 

7- 

99- 

99-3 

34 

30 

70 

62 

98.5! 

98. 

99. 

9».5 

"      20 

(J4 

76 

99- 

99-5 

34 

29-V 

So 

63 

93.5 

'98-9  ' 

"      21 

64 

So 

99.2 

100.  1 

3i  i 

26 

7° 

99- 

99.2 

"      22 

72 

9° 

on  £  V 

no  S 

34 

2O  1 

-0 

.>  >  J  i 

W'° 

^S/^ 

' 

"      23 

So 

99- 

99-8 

66 

98.6 



99-6 

"      24 

63 



35 

29! 

70 

99- 

992 

"      25 

66 

76 

994 

99-3 

35 

25i 

9^-5 

99-3 

"      26 

99.7 

[OO.  I 

^  - 

28 

73 

95.9 

99.2.7 

/° 

"      27 

74 

74 

99.6 

99-  "i 

34 

29i> 

90 

99- 

99-5 

"      23 

So 

34 

30 

82 

99.  2  j 

gS.S 

"     29 

73 

-3 

99-4 

99-5 

33 

27J 

93.5 



98.5 

"     30* 

63 

73 

99-71 

100. 

34 

27i 

"    3i* 

60 

76 

93-5 
99- 
93.4 

99-5 
99-5 
99- 

35 

30 

•• 

Sept.    I* 

70 

32 

995 



99-5 

35 

30 

2 

66 

76 

9S-5 
99.21 



99. 

99-5 



9S.2i 

98.7 

"      3 

66 

74 

99-3 

98.5 



99-5 
98.7 

33 

30 

•• 

"      4 

64 

98.4 



93-5 

"       5 

/o 

94 

99- 

99-71 

37i 

32 

.'ABLE   NO.  III. 

NO.  III. 


127 


7           Temperature.           n 

Dynamics. 

Gnns. 
Urine. 

Grms. 
Urea. 

Per 
Ct. 

Remarks. 

Mouth. 

Axitta. 

Vagina. 

Rectum 

Right. 

Left 

9S.2| 

98.2i 

98.3 

98.4 

34 

29 

856.863 
1255-747 
598.326 
797  7^9 

21.421 

i8.83C 
18.548 
27.921 

Ml 
Ilk 
3iV 
3A 



99-21 
99-2 

98.3 

33 

29 

^8. 

99- 

99- 

100. 

93.5 

34 
34 
33^ 
36 
35 
35 
3i 
33^ 
34 
33 
33 

33 
32 
33i 
37£ 
33]2 

30 
29 
29 
30 
30 
3° 
26* 
28» 

29 

27 
27 

28^ 

27 

271 

30 
30 

98-9 
99.6 
98.4 
99-5 
98.5 
99-7 
99- 
99.8 

99.2 

100. 

99. 

99-7i 
9«-5 
100.5 

856.863 

22.706 

*A% 

99-5 

100. 

1359.162 

25.824 

irS* 

99-5 

IOO.2* 

...... 

1388.719 

28.468 

*rfo 

99-5 
99-5 

994 

989.824 

25.240 

2V& 



99-7 

034.545 
620.487 
886.410 
738.675 
827.316 
418.256 
945.504 
590.940 
753.448 
531-846 
620.487 

23-785 
17-363 
18.614 
21.421 
20.682 
21.273 
23.637 
9.501 
21.096 
9.678 
21.899 

2A 
2A 
2A 
2A 
2lV 
I* 

«A 

»A 

2t% 

*& 

99.6 

99-9 



99'5 

99.6 

32 
36 

27J 

30 

128  THE   QUESTION   OF   REST   FOR   WOMEN. 


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»  £  s    5    -    c?c§    :^=    <£"£.-    = 


TABLE   NO.   IV. 


I29 


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1 30  THE    QUESTION   OF    REST    FOR    WOMEN. 


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TABLE   NO.   IV. 


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132  THE   QUESTION   OF    REST   FOR   WOMEN. 


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TABLE   NO.   V. 


133 


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UESTION   OF    REST    FOR   WOMEN. 


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TABLE   NO.   VI.  13$ 


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136  THE   QUESTION   OF    REST    FOR   WOMEN. 


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TABLE   NO.   VI. 


137 


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138  THE   QUESTION   OF   REST    FOR   WOMEN. 

A  glance  at  these  tables  taken  from  six  persons,  during  two 
or  even  three  months,  shows  that  the  average  amount  of 
urea  excreted  was  considerably  in  excess  of  the  amount  stated 
bv  Rabuteau.  His  figures  vary  from  14  to  22  grammes  daily, 
while  in  our  tables  the  amount  rarely  falls  bel'ow  20  grammes, 
is  much  more  frequently  25  or  28,  and  in  a  great  many  cases 
rises  to  35  or  38.  The  individual  variations  are  quite  marked. 
Thus  No.  II  shows  quite  a  high  range,  No.  V,  when  however, 
the  analyses  do  not  run  over  so  long  a  period,  has  a  lower 
average.  This  first  difference  between  Rabuteau's  table  and 
ours  is,  we  think,  to  be  explained  by  this  fact,  that  his  single 
case  was  a  woman  living  in  a  hospital,  perfectly  quiescent  in 
mind,  and  not  too  active  in  body,  while  our  cases  are  all 
students  subjected  to  considerable  mental  strain.  Any  in- 
crease of  this  strain  caused  an  immediate  increase  in  the 
amount  of  urea.1  Thus  in  No.  I,  after  twelve  hours  of  severe 
mental  and  bodily  fatigue,  68.585  grammes  of  urea  were  ex- 
creted. The  amount  of  urine  as  well  as  the  per  centage  of 
urea  were  both  exceedingly  increased.  On  another  occasion 
in  the  same  table  mental  anxiety  was'followed,  (July  16)  by 
a  rise  in  the  urea,  from  25.838  grammes  of  the  day  before  to 
35.345.  On  the  next  day,  complete  relaxation  being  taken, 
the  urea  fell  to  19.943  grammes.  In  No.  Ill,  after  mental 
anxiety  and  sleeplessness,  the  excretion  of  urea  rose  from 
25.114  grammes  to  33.476  grammes  (July  3ist).  In  No.  IV, 
on  July  27th,  the  amount  of  urea  rose  to  46.152  grammes, 
coincidently  with  mental  and  bodily  exertion.  The  highest 
amount  reached  on  any  other  day  than  this,  from  June  17  to 
August  3ist,  was  37.583  grammes  (July  3d).  In  No  V,  a 
week,  during  which  the  urea  varied  from  15  to  19  grammes, 
(and  a  fraction)  was  spent  in  sewing  (July  14-20,)  on  the  22d 
study  was  recommenced,  and  the  urea  rose  to  23.401  grammes. 
In  No  VI,  the  occasions  for  exertion,  all  midwifery  cases, 

1  We  have  recently  examined  the  urine  of  a  woman  suffering  from  incipient 
melancholia,  and  mentally  inactive,  and  the  excretion  of  urea  remained  at  14  or 
15  grammes  daily. 


SUMMARY   OF   ANALYSES   OF   UREA. 


139 


vary  extremely  in  the  amount  of  urea.  Thus  the  first,  when 
forceps  was  used,  only  18.614  grammes  were  said  to  be  ex- 
creted ;  on  the  second  occasion,  28.365  ;  on  the  fourth, 
23,932;  on  the  fifth,  31.497  ;  and  on  the  sixth,  32.720.  It  is 
possible  that  the  exertion  involved  more  expenditure  of 
muscular  than  mental  force. 

The  amounts  of  urea  excreted  on  any  given  day  of  the 
menstrual  period,  (the  days  of  the  flow  are  marked  with  an 
asterisk  in  the  tables),  vary  very  much.  Thus  in  No  I,  the 
large  amount  of  urea  excreted  on  June  I9th,  coincided  with 
the  first  day  of  menstruation.  At  the  first  day  of  the  next 
menstruation  (July  16),  the  amount  was  only  25.838  grammes. 
The  rise  on  the  second  day  again  coincided  with  the  mental 
anxiety  as  before  noticed,  and  the  fall  the  third,  in  con- 
nection with  an  afternoon  of  relaxation,  took  place  in  spite 
of  the  continuance  of  the  menstrual  flow.  In  No.  II,  the 
first  menstrual  period,  (July  2-4)  contains  higher  amounts 
of  urea  than  at  any  other  period  on  the  table  (41.129),  but 
the  amount  on  the  second  day  (37.642  grammes)  is  equalled 
on  several  non-menstruating  days,  and  the  amount  on  the 
first  day  (31.724)  falls  below  that  of  several  other  days. 

Perceiving  that  these  individual  figures  would  be  of  little 
value,  we  have  compiled  a  summary  from  the  tables,  showing 
the  sum  total  of  different  days. 

No.  I.— EXCRETION   OF   UREA   DURING 


5  days  preceding 
menstruation. 

5  days  of  menstrua- 
tion. 

5  days  following 
menstruation. 

5  days  in  middle 
inter  menstruation 
period. 

134.870  Grms. 

133.542  Grms. 

118.485  Grms. 

121.731 

No.  II.— EXCRETION   OF   UREA   DURING 


1st  m. 

3  days  before 
menstruation. 

3  days  of 
menses. 

3  days  succeeding 
menses. 

3  days  in  middle 
interm.  period. 

97.020 

110.495 

106.367 

90.580 

140 


THE   QUESTION   OF    REST    FOR   WOMEN". 


2d  m. 

menses. 

menses. 

menses. 

interm.  period. 

S6.iSo 

94.667 

-5.285 

78.150 

3d  m. 

menses. 

menses. 

menses. 

79.612 

SS.3SS 

81.020 

No.  III.— EXCRETION    OF    UREA    DURING 


3d  m. 

"  davs  of 

menses. 

menses. 



52.692 

53-6oS 

90.257 

4th  m. 

3  days  before 
menses. 

3  days  of 
menses. 

3  days  succeeding 
menses. 

3    days    middle 
interm.  period. 

57.198  Grms. 
(diarrhoea.) 

65.392                        60.275 

79-532 

2d  m. 

3  days  before 
menses. 

3  days  of         3  days  succeeding 
menses.                    menses. 

3    davs    middle 
interm.  period. 

82.058 

77-S33                        65-548 

93- 

No.  IV.—  EXCRETION    OF    UREA    DURING 

istm. 

5  days  before 
menses. 

5  days  of 
menses. 

5  days  succeeding 
menses. 

146.429 

144-955 

122.023 



2d  m. 

5  days  before 
menses. 

5  days  of 
menses. 

5  davs  succeeding^  davs  in  midst  of 
menses.           |    interm.  period. 

3d  m. 

152.046 

137.169 

155-577 

H7.254 

5  days  before 
menses. 

5  days  of 
menses. 

5  days  in  midst  of 
interm.  period. 

142.139 

120.142 

132.797  Grms. 

SUMMARY   OF   ANALYSES  OF   UREA. 
No.  V.— EXCRETION   OF   UREA   DURING 


4  days  before  menses. 

4  days  out  of  6  menses. 

4  days  succeeding  menses. 

125.247 

87-457 

70.522 

No.  VI.— EXCRETION   OF   UREA   DURING 


istm. 

2  days  before 
menses. 

2  days  of 
menses,  (days) 

2  days  succeeding 
menses. 

2   days   middle 
interm.  period. 

38.288 

31-939 

37-614 

3L094 

2d  m. 

5  days  before 
menses. 

5  days  of 
menses. 

5  days  succeeding 
menses. 

5    days   middle 
interm.  period. 

138.057 

134.506 

122.073 

127.499 

3d  m. 

5  days  before 
menses. 

5  days  of 
menses. 

5  days  succeeding 
menses. 

5    days   middle 
interm.  period. 

I53-998 

153.998 



156.281 

The  most  constant  relation  discoverable  from  these  tables 
is  that  between  the  amount  of  urea  during  menstruation  and 
during  the  days  immediately  following.  Out  of  fourteen 
cases  (distributed  among  six  persons),  the  urea  diminished 
quite  markedly  in  ten.  In  two  cases  there  is  a  slight  increase, 
and  in  two  (the  3d  month  of  No.  VI.),  and  the  3d  of  No.  III., 
the  urea  is  not  estimated  during  the  post-menstrual  week. 
The  percentage  of  the  diminution  after  the  cessation  of  the 
flow  is  extremely  variable.  Estimating  the  difference  as  the 
percentage  of  the  amount  eliminated  during  the  menstrual 
flow,  we  have  in  one  case  3  per  cent.,  in  two  cases  8  per 
cent.,  in  one  2  per  cent.,  in  one  n  per  cent.,  in  one  15  per 
cent.,  in  one  19  per  cent.,  in  one  20  per  cent.,  in  one  25 
per  cent.,  and  in  one  29  per  cent. 

In  five  cases  out  of  the   eight   in  which  this  detail  is 


142  THE   QUESTION   OF   REST   FOR   "\YOMEX. 

specified,  the  amount  of  urea  immediately  after  menstruation 
•was  less  than  the  average  for  the  corresponding  intermen- 
strual  period  ;  in  the  other  three  it  was  more. 

The  relation  of  the  amount  of  urea  excreted  during  men- 
struation to  that  excreted  just  before,  varies  with  the  persons. 
It  is  diminished  in  No.  I.  (one  analysis),  in  No.  IV.  (three 
analyses),  in  No.  V.  (one  analysis),  and  in  No.  VI.  (three 
analyses);  also  in  one  out  of  three  analyses  of  No.  III.  In 
two  analyses  of  No.  III.  it  is  increased,  and  in  the  three 
analyses  of  No.  II.  There  seems  reason  to  suppose  that  the 
individual  tendency  predominates;  still,  in  the  majority  of 
the  cases  (nine)  we  can  say  that  the  urea  is  diminished  during 
the  flow  ;  in  five  increased.  We  have  said  that  in  the  decided 
majority  of  our  cases,  the  urea  during  menstruation  was 
more  abundant  than  during  the  week  immediately  following. 
In  comparing  it,  however,  with  the  amount  excreted  during 
a  corresponding  number  of  days  at  intermenstrual  periods, 
we  find,  out  of  fourteen  cases,  in  four  it  is  not  specified,  in 
one  the  quantity  is  the  same,  in  four  it  is  less,  and  in  five 
more. 

No  conclusion  can  be  drawn  from  this  limited  number  of 
cases,  where  the  variations  are  much  greater  than  in  the 
other  proportions.  This  is  probably  owing  to  the  fact  that 
the  amount  of  urea  is  always  influenced  by  a  variety  of  cir- 
cumstances, among  which  menstruation  only  counts  for  one. 

The  most  general  result  to  be  deduced  from  these  tables 
is  the  following. 

During  the  few  days  preceding  the  menstrual  flow,  the 
excretion  of  urea  is  generally  increased  above  the  average  at 
intermenstrual  periods  (seven  cases  out  of  ten  specified).  In 
the  majority  of  cases  (nine  out  of  fourteen),  the  urea  dimin- 
ishes from  this  excess  during  the  flow,  while  in  a  minority  of 
cases  ('five  out  of  fourteen),  it  continues  to  increase.  The 
alternative  of  increase  or  diminution  seems  to  depend  on 
peculiarities  generally  persistent  in  the  same  individual. 


AVERAGE  OF  PULSE  AND  TEMPERATURE. 


143 


In  the  great  majority  of  cases,  the  urea  decreases  markedly 
after  the  cessation  of  the  menstrual  flow  (ten  cases  out  of 
twelve  specified) ;  and  in  the  two  cases  in  which  an  increase 
seems  to  have  existed,  it  was  much  slighter  than  the  usual 
decrease. 

The  average  of  pulse  and  temperature  have  been  exam- 
ined in  the  same  way. 


TABLE  No.  I.— P.  AND  T.,  FIVE  DAYS  AVERAGE. 


Pulse. 

Rectal  Temperature.    A.M. 

Before. 

During. 

After. 

Iiiterm. 

Before. 

During. 

After. 

Interm. 

50 

5° 

49 

54 

99-36 

99.26 

99.78 

99.18 

TABLE  No.  II.— P.  AND  T.,  AVERAGE  THREE  DAYS. 


Pulse. 

Rectal  Temperature.    A.  M. 

istm. 

Before. 

During. 

After. 

Interm. 

Before. 

During. 

After. 

Interm. 
99.25 

70 

69 

70 

7o| 

98.75 

98.75 

98.58 

ad  m. 

74 

72f 

74 

74 

99.16 

98.91 

98.50 

99.00 

TABLE  No.  III.— P.  AND  T.,  AVERAGE  THREE  DAYS. 


Pulse. 

Rectal  Temperature.    A.  M. 

2dm. 

Before. 

During. 

After. 

Interm. 

Before. 

During. 

After. 

Interm. 

70| 

68 

70 

70| 

99-8 

99-36 

99-23 

99-73 

3d  m. 

67 

65i 

72 

83 

99.6 

99-43 

99.50 

99-43 

4th  m. 

84 

66 

65i 

99-53 

99.66 

99-23 

.... 

144  THE   QUESTION   OF   REST   FOR   WOMEN. 

TABLE    No.    IV.— P.   AND    T.,  AVERAGE    FIVE    DAYS. 


Pulse. 

Rectal  Temperature.     A.  M. 

ist  m. 

Before. 

During. 

After. 

Interm. 

Before. 

During.         After. 

Interm. 

76 

78 

So 

77 

98.60 

99-33 

99.12 

9840 

2<j  in. 

So 

80.8 

73-2 

Si.  6 

99-32 

99.25 

99-5 

99-38 

3d  m. 

964 

82 

81.6 

I  OO.  I  I 

101.23 



99.38 

TABLE    No.  V.— P.    AND    T.,  AVERAGE    SIX    DAYS. 


Pulse. 

Rectal  Temperature.     A.  M. 

Before. 

During. 

Interm. 

74 

73! 

76^ 

67 

98 

99.58 

99.29 

99-33 

TABLE   No.  VI.— P.    AND    T.,   AVERAGE    FIVE    DAYS. 


Pulse. 

Rectal  Temperature.    A.  M. 

Before. 

During. 

After. 

Interm. 

Before. 

During. 

After. 

99 

2cl  m. 

74 

73 

71 

71 

99- 

98.8 

98.6 

3d  m. 

74 

77 

71 

99.86 

99.58 

.... 

99 

The  results  from  these  tables  do  not  justify  either  the 
description  of  a  "  febrile  condition  "  occasioned  by  menstrua- 
tion (Allan  Thomson),  or  a  "  lowering  of  pulse  or  tempera- 
ture" (Rabuteau),  as  constant  conditions.  In  Nos.  I,  II, 
and  III,  the  pulse  during  the  flow  was  a  few  beats  lower 
than  during  intermenstrual  period  ;  but  in  Nos.  IV,  V,  and 
VI,  it  was  about  as  much  higher.  As  regards  the  tempera- 
ture, in  the  ist,  3d,  4th,  5th,  ;th,  8th,  9th,  and  nth  analyses 
(eight  out  of  twelve)  the  temperature  was  diminished  during 


COMPARISON   OF   TEMPERATURES. 


145 


the  flow,  but  very  slightly,  from  .07  of  a  degree  to  .44 — 
never,  therefore,  as  much  as  half  a  degree.  In  one  case  the 
temperature  was  exactly  the  same  during  the  flow  as  during 
the  preceding  week;  in  one  there  was  a  rise  of  .13  of  a 
degree  ;  in  one  of  i£  degrees ;  and  in  one  the  temperature 
was  decidedly  febrile  (101.23),  rising  1.12  over  that  of  the 
preceding  week. 

In  eight  cases  out  of  eleven  in  which  intermediate  tem- 
perature is  given,  we  find  that  the  premenstrual  temperature 
was  higher  than  the  average  existing  between  the  periods. 
The  excess  ranges  from  .07  to  .86  of  a  degree. 

The  following  table  compares  at  a  glance  the  two  sets  of 
variations  : 


Excess  Premenst. 

over  Menst. 

Excess  Pr 

emenst.  over  Inter 

m. 

8  cases  out  of 

2,  fractions  of  a  degree. 

8  cases  out  of 

n,  fractions  of  a  degree. 

.07      .    .    . 

2C 

28 

17 

.50 

•73. 
.86 

.17      .    .    . 

.      .26 

....      44 

07 

18 

.20      .    .    . 

.27 

16 

"'O 

This  shows,  as  indeed  can  be  seen  by  reference  to  the 
previous  tables,  that  the  diminution  of  temperature  observed 
during  the  menstrual  flow  is  hardly  ever  (three  cases)  to  a 
point  below  the  average,  but  only  below  the  level  of  a  tem- 
perature that  had  been  attained  just  previously.  That  is  to 
say,  the  temperature  rises  from  one  to  eight-tenths  of  a 
degree  during  the  week  preceding  .menstruation.  It  falls 
gradually  during  the  flow,  but  in  the  majority  of  cases  does 
not  even  then  reach  the  normal  average. 

An  attempt  has  been  made  to  estimate  possible  variations 
in  muscular  force  in  relation  to  menstruation. 

This  estimate  is  imperfect  because  only  based  upon  trials 
made  with  the  hand  dynamometer.  In  the  comparative 
estimates  of  muscular  force  in  men  and  women,  as  they  have 


I46 


THE   QUESTION   OF   REST    FOR   WOMEN. 


been  made  by  Quetelet,1  the  results  obtained  by  this  instru- 
ment were  supplemented  by  others  obtained  by  Regnier's 
dynamometer  for  measuring  the  strength  of  the  muscles  of 
the  back  and  loins.  During  menstruation,  however,  it  might 
be  expected  that  the  force  of  this  set  of  muscles  would  be 
diminished,  out  of  proportion  to  that  of  the  rest  of  the  body. 
The  following  averages  have  been  obtained  with  the 
dynamometer.  We  have  made  from  the  general  tables  a 
summary  of  a  few  days,  only  taking  the  test  with  the  right 
hand  and  for  the  morning. 

TABLE    No.    I.— DYNAMOMETER    TEST,    FIVE    DAYS. 


Before  Menst. 

During  Menses. 

After  Menses. 

Intermenst. 

29! 

281 

28-i 

26!  or  27 

TABLE    No.   II.— DYNAMOMETER    TEST,   THREE    DAYS. 


Before. 

During. 

After. 

Intermeust. 

ist  in. 

28 

30.16 

29.66 

33-5 

2(1  m. 

35 

36.5 

34 

34-  1  6 

3d  m. 

35-5 

35-5 

36 

36 

TABLE    No.    III.     DYNAMOMETER    TEST,    THREE    DAYS. 


Before. 

During. 

After. 

Interment. 
32.33 

ist  m. 

26.66 

26.16 

2cl  m. 

32.83 

33-5 

34-16 

34-5 

3d  m. 
4th  m. 

32 

32.66 

33-i6 

33.66 

31.33 

33 

1  To  which  we  shall  have  occasion  to  refer. 


COMPARISON   OF   TEMPERATURES.  147 

TABLE   No.    IV.     DYNAMOMETER   TEST,   THREE   DAYS. 


Before. 

During. 

After. 

Intermenst. 

ist  m. 

25.2 

25.8 

25.2 

25- 

2d  m. 

24.4 

26. 

28.8 

3d  m. 

25.8 

26. 

,  '  .  .    - 

TABLE   No.   V.     DYNAMOMETER   TEST,   THREE   DAYS. 


Before. 

During. 

After. 

Intermenst. 

29.16 

28.5. 

30.16 

28.33 

In  the  sixth  case,  muscular  power  was  tested  by  lifting 
weights,  calculated  from  the  tables.     For  five  days  we  have — 


TABLE   No.   VI. 


Before. 

During. 

After. 

Intermenst. 

ist 

255  Ibs. 

253  Ibs.  average. 

245  Ibs. 

260  Ibs. 

2d 

275  Ibs. 

264  Ibs. 

260  Ibs. 

260  Ibs. 

292  Ibs. 

288  Ibs. 

Out  of  fifteen  examinations  on  these  tables,  the  muscular 
strength  during  the  menstrual  flow  was  less  than  that  during 
the  preceding  days  in  seven  cases,  was  increased  in  seven,  and 
in  one,  was  exactly  the  same. 

It  is  Table  VI,  where  the  test  was  made  by  the  lifting  of 
weights,  that  the  diminution  was  most  uniform,  notwith- 
standing a  constant  increase  in  muscular  power  during  the 
three  months  of  practice.  We  consider  this  the  most  reliable 


148  THE   QUESTION   OF   REST    FOR   WOMEN. 

table,  as  the  results  from  the  dynamometer,  except  for  com- 
parison between  the  right  and  left  hand,  are  too  much  influ- 
enced by  the  degree  of  skill,  the  force  of  the  hand  and  .wrist 
muscles,  not  ahvays  proportioned  to  that  of  the  rest  of  the 
bodv,  and  finally  by  the  most  transient  conditions  of  health. 
Transient  fatigue  is  excluded,  since  the  test  was  always  applied 
at  8  A.  M.  The  full  tables  show,  however,  that  the  evening 
test  was  by  no  means  inferior  to  the  morning. 

The  last  measurement  of  rhythmic  waves  of  nutrition  or 
vital  force,  that  we  have  been  able  to  make,  relate  to  sphyg- 
mographic  traces  of  the  radial  artery.  Before  considering 
these  traces,  we  will  quote  from  Landois,1  certain  laws,  that 
are  illustrated  by  our  cases  or  serve  to  explain  them. 

.  i.  The  dicrotic  elevation  (Riickstoss  elevation}  is  so  much 
the  greater,  the  less,  (cctcris  paribus]  the  tension  of  the  ar- 
terial walls,  and  vice  versa  (5th  Law,  p.  192.) 

2.  By  increase  of  pressure,  in  consequence  of  a  hindrance  to 
the  outflow,  the  elasticity  elevations  on  the  descending  curve, 
rise  higher  in  proportion  to  the  summit,  (/th  Law,  p.  199.) 

3.  By  very  low  tension  of  the  arterial  walls,  the  elasticity 
elevations  may  entirely  disappear.     This  happens  for  instance, 
when  there  is  a  great  diminution  of  the  blood,  from  a  hemor- 
rhage or  exhausting  disease  (8th  Law,  p.  200). 

4.  In  one  and  the  same  artery,  the  number  of  elasticity 
elevations  increases  with  the  degree  of  tension  of  the  arterial 
wall. 

5.  Increased    pressure    has    for    consequence    a    stronger 
primary  pulse  wave  and  more  marked  elasticity  elevations, 
without  an  essential  increase  of  the  dicrotic  elevation  (p.  125.) 

6.  Since  increased  activity  of  the  heart  increases,  cctcris 
paribus,  the   pressure   in  the  arterial   system,  it  causes  a  rise 
in  the  level  of  the  entire  curve. 

7."  The  primary  pulse  wave  rises  when  the  pressure  in  the 

1  Die  Lehre  vom  arterien  Pals,  1872. 

2  This  law  as  seen,  is  not  from  Landois. 


SPHYGMOGRAPHIC    TRACES.  149 

artery  is  increased  by  an  increased  mass  of  blood,  whether 
this  be  caused  by  expiration  (p.  193),  by  inspiration  of  com- 
pressed air,1  by  compression  of  a  large  artery  (p.  195)  by 
Morbus  Brightii  (p.  197.)  Diminution  of  the  mass  of  blood 
lowers  the  tension  and  increases  the  dicrotism. 

According  to  Waldenburg,  if  the  level  of  the  entire  curve 
rises,  while  the  height  of  the  primary  pulss  wave  diminishes, 
and  the  summit  becomes  more  round,  the  fullness  of  the 
artery,  and  the  tension  of  its  walls  are  both  increased.  If 
the  fullness  and  side  pressure  arc  diminished  the  dicrotism 
is  increased,  the  elasticity  elevations  diminished,  the  curve  is 
lower,  and  each  pulse  wave  smaller. 

The  following  traces  have  been  taken  with  Mahomed's 
sphygmograph,  in  which  exists  a  mechanism  for  varying  and 
accurately  estimating  the  degree  of  pressure  exerted  on  the 
artery  by  the  lever  of  the  instrument.  We  have  in  nearly 
all  the  cases,  taken  the  trace  at  four  degrees  of  pressure 
marked  respectively  2,  5,  6,  7  ;  pressure  5  gives  the  best 
average. 

No.  I  is  taken  from  a  young  woman  of  rather  delicate 
appearance,  but  in  good  health,  and  who  never  suffers  any 
inconvenience  during  menstruation.  The  premenstrual  pulse 
is  given  for  two  successive  months.  The  first  ranges  from 
December  22  to  December  24  (two  traces) ;  the  second  from 
January  14  to  January  22  (four  traces).  The  intermenstrual 
pulse  is  represented  by  the  two  traces  of  January  7  and 
January  u,  respectively  ten  and  fourteen  days  after  cessation 
of  menstruation. 

On  the  fourteenth  day  after  menstruation  (January  11) 
the  trace  is  as  follows :  primary  pulse  wave  (line  of  ascen- 
sion) moderately  developed,  summit  rounded,  showing  a 
fair  degree  of  fullness  of  artery  and  resistance  in  its  wall ; 

1  Waldenburg,  Die  Pneumatische.     Behandlung,  pp.  288,  290. 


150  THE   QUESTION   OF   REST    FOR   WOMEN. 

dicrotism  scarcely  perceptible,  elasticity  elevations  only  occa- 
sional;  the  entire  curve  elevated  and  arching  above  the 
starting  point ;  these  last  three  characters  all  indicating  good 
tension  and  well-filled  arteries. 

On  December  22  (first  premenstrual  trace)  the  primary 
pulse  wave  (ascension  line),  marked  5  and  7,  is  decidedly 
higher  than  the  corresponding  lines  on  January  n.  The 
summit  is  more  prolonged,  even  flattened,  in  line  7,  showing 
considerable  increase  in  the  tension.  In  line  5,  elasticity 
elevations  appear  distinctly.  The  rise  in  the  general  curve 
is  not  more  marked  for  line  5,  and  does  not  appear  very 
decided  in  line  7,  until  this  is  compared  with  the  similar  line 
in  January  11.  On  that  day  the  artery  seemed  unable  to 
resist  so  high  a  degree  of  pressure,  and  the  curve  sank  instead 
of  rising.  Moreover,  the  height  of  the  line  of  ascent  was  not 
greater  with  7  than  with  6  or  5.  But  three  days  before 
menstruation  the  line  of  ascent  is  much  higher  under  a  strong 
pressure  than  under  one  a  little  weaker.  All  these  characters 
indicate  a  considerable  increase  in  the  tension  of  the  artery, 
and  increased  resistance  of  the  wall.  Were  the  resistance 
only  increased,  the  line  of  ascent  would  be  lower,  even 
though  the  height  of  the  general  curve  remained  the  same. 

On  December  24,  one  day  before  menstruation,  the  curve 
is  a  little  more  elevated,  the  summit  more  rounded,  while 
the  line  of  ascent  is  more  oblique  than  on  either  December  22 
or  January  11,  but  not  so  high  (compare  lines  5  and  lines  6 
on  the  three  days). 

There  is  therefore  still  greater  fullness  of  the  blood  vessel 
and  resistance  of  its  wall  (pulsus  plenus).  For  this  month 
we  have  no  trace  during  menstruation  ;  but  two  days  after 
its  cessation  we  have  a  very  peculiar  trace.  The  pulse  was 
100,  the  line  of  ascent  brusquely  vertical,  increasing  in  height 
with  each  degree  of  pressure,  and  at  5,6,  or  7,  much  higher 
than  in  any  other  trace  from  this  subject.  The  summit, 


No.  I. 


ji  days  before  mei 


Dec.  3oth.  Pub 


No.   I  (continued] 


Jan.  ad,  Pulse  100.    5th  day  after  menses. 


Jan.  yth.     loth  day  after  menses. 


Jan.  iith.      i4th  day  after  menses. 


Jan.  i4th.     9  days  before  menses. 


No.  I.      (continued} 


Jan.   i6th. 


Jan.  2 1  st.     2  days  before  menses. 


Jan.  22d.     Day  before  menses. 


Jan.  23d.     18  hours  after  menses. 


SPHYGMOGRAPHIC   TRACES.  !$! 

instead  of  being  rounded,  forms  an  acute  angle  with  the  line 
of  ascent,  especially  noticeable  with  pressure  7.  The  dicrotic 
elevation  is  more  marked ;  the  elasticity  elevations  have 
altogether  disappeared.  These  characters  indicate  dimin- 
ished tension  in  the  arterial  walls,  combined  with  increased 
energy  of  the  cardiac  systole.  The  young  lady  felt  perfectly 
well,  and  could  refer  to  no  circumstance  capable  of  explain- 
ing this  remarkable  alteration  from  her  habitual  pulse,  altera- 
tion not  repeated  on  the  following  month.  Three  days  later 
the  pulse  is  still  100,  but  the  line  of  ascent  in  the  pulse-waves 
has  fallen  markedly  (compare  lines  5  and  6  for  the  two  days, 
December  30  and  January  2).  On  January  14,  nine  days 
before  the  next  menstruation,  the  fullness  of  the  artery  is 
much  increased,  as  indicated  by  the  marked  rise  in  the  curve, 
especially  at  pressure  7. 

The  line  of  ascent  is  again  higher,  and  the  summit  more 
rounded  than  in  the  intermenstrual  trace.  But  the  dicrotic 
elevation  is  more  perceptible,  and  there  are  no  elasticity 
elevations,  while  the  pressure,  resulting  from  fullness  of  the 
artery,  is  therefore  increased,  the  resistance  of  the  wall  seems 
to  be  somewhat  diminished.  On  the  i6th  these  characters 
were  less  marked  ;  on  the  2ist,  two  days  before  menstruation, 
the  curve  sinks,  and  all  the  characters  indicate  a  lowered  ten- 
sion of  the  radical  artery.  On  the  22d,  however,  the  tension 
rises  again,  and  (line  7)  elasticity  elevations  appear.  Finally, 
eighteen  hours  after  the  menstrual  flow  (January  23),  the 
trace  shows  greatly  diminished  fullness  of  the  artery  (curve 
low,  line  of  ascension  low,  summit  little  marked),  while  the 
tonicity  of  the  walls  is  not  diminished,  there  being  no  marked 
dicrotism.  The  same  characters  persist  on  the  day  after  the 
cessation  of  the  flow. 

No.  II  is  from  a  young  lady  of  robust  appearance,  but 
the  member  of  a  gouty  family,  and  herself  suffering  occasion- 
ally from  dyspepsia,  acne,  sciatica.  Very  little  pain  at  men- 


152  THE   QUESTION   OF   REST    FOR   WOMEN. 

struation,  but  great  weakness,  although  the  flow  is  not 
excessive.  On  this  account,  No.  II  habitually  remains  on 
the  sofa  during  four  or  five  days.  She  is  in  easy  circum- 
stances, and  not  compelled  to  any  exertion,  otherwise  it  is 
probable  that  this  would  be  found  more  possible  than  it 
appears.  Of  this  case,  unfortunately,  I  have  no  intermen- 
strual  trace,  but  two  sets  of  traces  for  menstrual  periods. 
On  December  28,  just  after  the  cessation  of  the  menses,  it  is 
evident  that  the  pressure  is  low.  The  curve  sinks,  and  the 
ascension  line  is  very  short.  The  resistance  of  the  arterial 
wall  is  not  especially  diminished,  or  else  the  signs  of  such 
diminution  (vertical  ascension  line,  dicrotic  curve,  peaked 
summit)  are  absent,  owing  to  the  diminution  in  the  contents 
of  the  artery,  and  in  the  energy  of  the  cardiac  systole.  The 
trace  on  the  second  post-menstrual  period  (January  21)  alto- 
gether resembles  this  first,  except  under  pressure  7,  the 
ascension  line  becomes  more  vertical,  and  the  dicrotic  eleva- 
tion is  more  marked.  In  the  other  lines,  a  trifle  more  full- 
ness in  the  artery  seems  indicated  by  a  little  more  roundness 
of  the  summit.  On  January  10,  four  clays  before  the  first 
menstruation,  a  striking  alteration  is  observed.  The  curve, 
though  not  high,  is  sustained  without  sinking;  the  ascension 
line  is  nearly  vertical,  and  much  higher,  but  the  summit  is 
tolerably  sharp.  This  shows  increased  force  of  the  heart's 
action,  without  a  corresponding  increase  in  arterial  tonicity. 
It  is  noticeable  that  the  height  of  the  ascension  line  increases 
with  the  degree  of  pressure  applied  up  to  6,  but  with  7  it 
falls  below  that  of  2. 

This  is  the  reverse  of  what  is  observed  in  No.  I,  Decem- 
ber 30.  It  seems  to  imply  that  the  vigor  of  the  cardiac 
systole  would  not  be  sufficient  to  so  greatly  develop  the 
primary  pulse  wave  if  the  resistance  of  the  arterial  wall  were 
very  great.  At  the  same  time  the  dicrotism  is  little  marked, 
and  elasticity  elevations  appear.  On  the  whole,  therefore, 
the  tension  is  raised  by  intra-arterial  pressure.  January  12, 


No.  II. 


No.   II.      (continued). 


Jan.  1 3th.     i  day  before  menses. 


Jan  i4th.     ist  day  menses. 


Jan.  i  yth.     4th  day  menses. 


Jan.  zist.     Menses  ceased  Jan.  ipth. 


SPHYGMOGRAPHIC   TRACES.  153 

two  days  before  menstruation,  these  characters  persist,  ex- 
cept that  the  primary  pulse  wave  is  smaller  with  pressure 
2,  and  much  increased  with  pressure  7.  Dicrotism  is  more 
marked,  the  elasticity  elevations  less  so,  showing  that  while 
the  pressure  remains  the  same,  the  resistance  is  somewhat 
lessened.  On  January  13,  the  day  preceding  menstruation, 
the  resistance  is  decidedly  diminished,  the  pressure  remain- 
ing nearly  the  same  ;  the  angle  of  the  summit  is  quite  acute, 
the  dicrotism  much  -more  marked.  On  January  14,  the  first 
day  of  menstruation,  the  intra-arterial  pressure  falls,  but  the 
resistance  is  somewhat  increased,  as  indicated  by  a  more 
oblique  line  of  ascent,  and  a  more  rounded  summit.  On  the 
fourth  day  of  the  hemorrhage  (January  17)  the  pressure  is 
reduced  to  the  minimum,  being  lower  even  than  on  the  two 
post-menstrual  days,  December  28  and  January  21.  The 
curve  in  trace  under  pressure  5  sinks  notably,  and  6  and  7 
are  very  much  less  distinct  than  on  two  days  after  men- 
struation. There  (line  7),  though  the  resistance  is  low,  as 
shown  by  the  dicrotism,  the  primary  pulse  wave  is  tolerably 
developed,  but  on  the  I7th  it  is  extremely  small. 

No.  Ill  exhibits  the  pulse  of  an  extremely  robust  person, 
sanguine  temperament,  vigorous  health.  The  menstruation, 
however,  generally  came  only  every  five  or  six  weeks,  but 
then  was  normal  in  quantity  and  unattended  by  incon- 
venience. It  is  noteworthy  that  this  person,  though  only 
about  thirty  years  old,  was  very  fat.  The  premenstrual 
traces  were  taken  on  the  ninth,  seventh,  and  second  day 
before  menstruation  (December  22,  24,  29).  The  trace  on 
January  16,  ten  days  after  menstruation,  is  the  nearest  we 
have  to  a  complete  intermenstrual  trace,  to  serve  for  term 
of  comparison.  The  primary  pulse  wave  is  fairly  developed, 
the  summit  rounded,  but  dicrotism  is  very  distinct.  We 
should  infer  arteries  tolerably  well  filled,  but  with  not  very 
resistant  walls.  Such  are  precisely  the  characters  to  be 
expected  in  well  nourished,  plethoric  fat  people,  in  whom 


154  TIIE   QUESTION   OF   REST   FOR   WOMEN. 

muscular  tissue  is  never  adequately  developed.  Nine  days 
before  menstruation  (December  22)  the  tension  falls,  the 
height  of  the  ascension  line  is  somewhat  increased,  showing 
greater  plenitude,  but  the  summit  is  more  angular,  and 
dicrotism  more  marked.  The  trace  on  December  24  was 
taken  an  hour  after  the  young  lady  had  drunk  a  glass  of  light 
wine,  to  which  she  was  unaccustomed.  While  interesting  as 
showing  the  effect  of  wine  in  increasing  both  the  cardiac 
systole  and  arterial  tonicity,  it  is  of  little  avail  for  our  pur- 
pose. Two  days  before  menstruation  the  plenitude  of  the 
artery  is  increased,  as  shown  by  the  rise  of  the  curve ;  the 
other  characters  remain  almost  as  on  December  22,  only  the 
line  of  descent  descends  much  less  abruptly.  On  the  first 
day  of  menstruation  the  tension  is  much  increased,  there  is 
no  angle  at  the  summit,  the  line  of  descent  is  very  gradual, 
the  dicrotism  is  almost  completely  obliterated.  Nine  days 
after  cessation  of  menses,  the  fullness  of  the  artery  is  greatly 
diminished,  and,  possibly  on  that  account,  the  arterial  tension 
seems  to  be  relatively  increased.  We  have  taken  the  follow- 
ing day  as  the  type  of  the  intermenstrual  period. 

No.  IV  is  the  pulse  of  an  ansemic  and  neurotic  person, 
who  suffers  a  good  deal  of  cramp-like  pain  during  menstrua- 
tion. When  this  person  is  in  poor  health  and  losing  flesh, 
menstruation  occurs  with  great  regularity  every  month  ;  as 
soon  as  she  improves  in  strength  and  gains  in  flesh,  men- 
struation recurs  only  every  six  weeks,  and  is  much  less  pain- 
ful. Her  period  of  greatest  vigor  is  during  the  week  (or 
three  weeks  in  the  six  weeks'  menstruation  cycle)  that  pre- 
cedes the  monthly  flow.  At  the  time  of  taking  the  traces, 
the  menstruation  was  delayed  seventeen  days,  and  so  the 
traces  of  December  30,  31,  January  3  and  January  4,  all  rep- 
resent the  premenstrual  condition.  December  30  and  Jan- 
uary 3  are  the  most  accurate  in  this  respect.  The  intermen- 
strual trace  has  unfortunately  been  lost,  but  the  plenitude 
of  December  30  is  very  marked.  On  December  31  the  trace 


No.  III. 


Dec. 


Dec.  24th.     7  days  before  menses. 


1  [       (continued] 


' 


Jan.  i6th.     10  <1 


No.   IV. 


.No.   IV.    (continued?) 


Dec.  jist.     After  Excitement.     Menses  expected  Dec.  3ist ;  arrived  Jan.  i8th. 


Jan.  3d.     Menses  ut  supra. 


Jan.  4th.     Menses  ut  supra. 


Jan.  26th.     Menses  just  ceased. 


rV: 


»*fi 


No.  V 


Dec.  xist-     isi  day 


Dec,  27th.     Meases  ceased  Dec, 


No.   V.  (continued.) 


Dec.  3ist.     Menses  ceased  Dec.  26th. 


Jan.  4th.     1 1  days  after  menses. 


SPIIYGMOGRAPHIC   TRACES.  155 

was  taken  while  the  patient  was  still  under  the  influence  of 
strong  excitement  from  annoyance.  There  was  probably 
spasmodic  contraction  of  arteries  from  vaso  motor  irritation. 
On  January  3,  still  nearer  to  menstruation,  the  primary  pulse 
wave  is  still  more  developed,  indeed  out  of  proportion  to  the 
resistance,  so  that  the  summit  is  peaked,  especially  in  the  trace 
under  pressure  6  ;  dicrotism  is  more  marked.  In  a  condition 
like  this,  when  menstruation  really  arrived  as  expected,  the 
patient  habitually  began  to  suffer  from  ovarian  pain.  On 
January  4  the  pulse  is  again  changed,  under  the  influence  of 
a  profuse  sweating  from  a  dose  of  Jaborandi,  given  with  the 
express  purpose  of  lessening  the  intra-arte'rial  pressure.  It 
is  evident  from  the  trace  that  the  effect  was  obtained.  It 
was  impossible  to  obtain  a  trace  on  the  first  day  of  men- 
struation. The  trace  on  January  26  represents  the  condition 
just  after  the  cessation  of  the  flow.  The  emptied  condition 
of  the  artery  is  shown  by  the  sinking  of  the  curve,  as  well  as 
by  the  smallness  of  the  primary  pulse  waves.  On  February 
21,  which  corresponds  to  January  4,  inasmuch  as  the  men- 
struation was  expected,  yet  did  not  arrive  until  ten  days 
later,  the  characters  of  the  trace  very  much  resemble  those 
on  that  day.  The  tension  is  raised,  the  fullness  somewhat 
increased,  very  markedly  so  over  the  post-menstrual  trace  of 
January  26. 

No.  V  is  taken  from  a  very  healthy  young  woman,  but 
rather  pale,  and  who  rarely  menstruates  more  than  once  in 
three  or  four  months.  She  did,  however,  menstruate  on 
December  21,  and  again  on  January  23,  which  she  considered 
exceptional.  January  4  and  January  II,  give  the  average 
intermenstrual  traces.  The  only  premenstrual  trace  is  on 
January  13,  and  this  is  as  much  as  ten  days  before  the  flow. 
It  is  evident  from  comparison  of  lines  6  and  7,  that  the  pleni- 
tude of  the  artery  is  increased  more  than  the  tension  ;  the 
summit  being  peaked,  and  dicrotism  more  marked.  There 
are,  however,  elasticity  elevations  on  the  line  of  descent. 


156  THE   QUESTION   OF   REST    FOR   WOMEN. 

The  first  day  of  menstrual  period  (though  not  that  following 
the  trace  on  January  13)  shows  increased  tension,  (especially 
at  pressure  5,)  and  diminished  fullness.  The  dicrotism  dis- 
appears, is  replaced  by  elasticity  elevations,  while  the  line  of 
descent  is  a  little  less  abrupt,  but  the  line  of  descent  is  lower 
and  the  curve  sinks.  On  the  fourth  day,  December  24,  the 
primary  pulse  wave  is  still  less  developed.  The  day  after 
cessation  of  the  flow,  it  is,  however,  much  more  developed, 
and  on  the  fifth  day  after,  December  31,  the  trace  is  more 
vigorous  than  any  of  the  series.  On  the.  tenth  day,  January 
3,  the  pulse  becomes  very  miserable,  the  entire  curve  sinking. 
It  is  even  less  developed  than  on  January  27,  the  day  mark- 
ing the  cessation  of  the  second  menstrual  period. 

This  case,  therefore,  is  by  no  means  so  regular  in  its  evo- 
lution as  those  hitherto  examined,  and  is  evidently  more  in- 
fluenced by  transient  conditions,  still  the  general  tenor  is  the 
same. 

No.  VI,  is  from  a  very  healthy  young  girl  of  twenty,  well 
nourished,  well  colored,  with  good  muscular  capacity,  men- 
struating regularly  and  with  very  little  pain.  The  nearest  ap- 
proach we  have  to  our  intermenstrual  trace,  is  on  January 
24,  nine  days  after  menstruation.  Taking  it  as  a  standard 
comparison,  we  find  on  February  8,  two  days  before  a  men- 
strual period,  that  then  the  tension  is  diminished,  without  any 
evident  increase  in  arterial  fullness.  For  the  dicrotism  is 
increased,  while  the  primary  pulse  wave  remains  the  same. 
We  have  already  noticed  instances,  when  the  fullness  and 
tensions,  increased  a  week  before  menstruation,  were  both 
lowered  on  the  second  day  preceding  it.  On  January  1 1,  the 
second  day  of  a  menstrual  period,  the  plenitude  is  very  much 
increased,  but  the  resistance  is  diminished,  peaked  summit, 
abrupt  line  of  descent,  dicrotism,  primary  pulse  wave  higher 
under  pressure  five,  than  with  six,  and  this  higher  than  seven. 
On  January  15,  day  of  cessation,  plenitude  diminished, 
tonicity  increased.  This  is  especially  shown  by  the  firm 


No.   \ 


Jan..  1 i 


Jan.  T5th.     Menses  <  tast-d  to-day. 


No.  VI.  (continued} 


SPHYGMOGRAPHIC   TRACES.  157 

and  vigorous  tracing  under  pressure  seven.  The  curves  en 
masse  sink.  Two  days  after  menses  the  artery  is  full  again. 
Its  tracing  showing  a  combination  of  plenitude  and  tonicity, 
is  in  marked  contrast  with  that  of  January  1 1,  when  plenitude 
existed  without  the  tonicity. 

No.  VIJ  is  from  a  young  German  servant  eighteen  years 
old,  in  good  health,  but  rather  pallid.  December  19,  repre- 
sents the  intermenstrual  trace,  which  shows  considerable 
plenitude  of  the  arteries,  and  well  marked  tonus.1  On  the 
twenty-fourth,  nine  days  before  menstruation,  these  char- 
acters are  increased,  and  the  pulse  is  considerably  accelerated 
(the  number  of  pulse  beats  has  been  omitted).  On  the  sec- 
ond of  menstruation  (January  5,)  the  height  of  the  primary 
pulse  wave  is  lowered,  and  a  little,  dicrotism  appears.  But 
upon  abrupt  cessation  of  the  flow  on  the  second  day  under 
the  influence  of  violent  moral  emotion,  the  plenitude  and 
arterial  tension  are  both  raised  to  the  highest  point  in  the 
series,  at  this  time  the  girl  suffered  from  a  throbbing  headache. 

No.  VIII  is  from  a  person  who  represents  the  most  typi- 
cal health  of  any  on  the  list,  a  young  married  woman,  six 
months  after  cessation  of  lactation,  menstruation  perfectly 
regular  and  painless.  This  person  possessed  fine  muscular 
tone,  and  is  recorded  elsewhere  on  our  tables,  as  capable  of 
walking  twenty  miles.  The  intermenstrual  trace  is  repre- 
sented at  the  bottom  of  the  sheet.  Four  days  before  men- 
struation, the  level  of  the  curve  rises,  the  summit  of  the 
angle  becomes  much  more  rounded.  On  the  first  day  of 
menstruation,  all  these  characters  change,  the  curve  rises  less 
or  sinks,  the  primary  pulse  wave  is  a  little  developed.  But 
though  the  fullness  of  the  artery  is  much  diminished  the 
tension  is  not,  as  shown  by  the  elasticity  elevations.  Ten 
days  after  menstruation  the  pressure  and  tensions  have  begun 
to  rise  again,  and  continue  to  do  so  until  reaching  a  maxi- 

1  I  have  never  examined  this  subject's  heart,  and  from  the  trace,  suspect  a 
little  hypertrophy. 


158  THE  QUESTION   OF   REST   FOR   WOMEN. 

mum  (on  our  table)  four  days  before  the  period.     It  is  very 
possible  that  the  real  maximum  was  reached  seven  days  before. 
From  these  experiments,  at  all  events  until  they  should 
be  contradicted  by  others,  we  are  justified  in  affirming: 

1.  That,  taking  the  middle  of  the  intermenstrual  period 
for  point  of  comparison,1  there  is  an  increase  in  the  tension 
of  the   arteries,  dependent  on  an  increase  in  their  plenitude 
during  the  seven  to  nine  days  preceding  menstruation.     Nos. 
I,  II,  III,  IV,  VII,  VIII. 

2.  In  one   of  the   two   cases  where  this  does  not  appear 
clearly  demonstrated  by  our  tables  (No.  V),  the  menstrua- 
tion was  of  an  unusual  type  ;  and  we  lack,  moreover,  tables 
of  premenstrual  days  nearer  than  the  tenth.     This,  however, 
shows  an  increase  of  fullness,  though  not  of  tension,  over  the 
intermenstrual   trace.     In   the   other  case  (No.  VI),  we   are 
again  deficient  in  the  premenstrual  trace  for  any  day  but  the 
second. 

3.  The   increase   of  plenitude   and   tension  may  be  more 
marked  seven  or  eight  days  before  menstruation  than  on  the 
first  or  second  day  before  (Nos.  I,  II),  or  the   increase   may 
continue  up  to  the  very  day  of  the  flow  (Nos.  Ill,  VIII).     In 
this   case   the  first   day  of  the  flow  may  exhibit  little  or  no 
lowering  of  the  pressure  or  tension  (No.  Ill),  or  even  show 
increased  pressure  (Nos.  V  and  VI). 

4.  As   a  rule,  however,  the   pressure   and   tension  in  the 
artery  are    both   markedly   lowered    a    few   hours    after  the 
beginning  of  the  hemorrhage  (No.  I,  II,  V,  VII,  VIII),  and 
continue  to  diminish  as  long  as  this  lasts  (No.  V). 

5.  The    lowest   point   is    reached    immediately   after    the 
cessation  of  the  flow  (January  26  of  No.  I,  No.  IV),  and  this 
degree  may  continue  for  several  days  (Nos.  Ill,  V,  VIII).     In 
some  cases,  however,  the  plenitude  and  tension  become  in 

1  "Over  the  degree  of  pressure,  the  strength  of  the  cardiac  systole,  etc.,  sphyg- 
mographic  observations  have  only  a  relative  value." — Cyon.  Methodic,  der  Phy- 
siol.  Experiments,  1876,  p.  165. 


is   |«L 


Jan. 


Jaa.  ;th.     Menses  ceased  abruptly  <*.  . 


NCL  VIII 


RHYTHM   OF   ARTERIAL   TENSION.  1 59 

two  days  much  increased  over  their  condition  on  the  fourth 
day  of  menstruation,  or  even  on  the  first  day  after  (Nos;  II, 
VI,  December  30  of  No.  I). 

6.  We  should  conclude,  therefore,  that  in  women  exists  a 
rhythmic  wave  of  plenitude  and  tension  of  the  arterial  sys- 
tem, at  all  events  perceptible  in  the  radical  artery,  which 
begins  at  a  minimum  point,  from  one  to  four  days  after  the 
cessation  of  menstruation,  and  gradually  rises  to  a  maximum, 
either  seven  or  eight  days  before  menstruation,  or  at  any  day 
nearer  than  this,  or  even  during  the  first  day  of  the  flow. 

That  the  resistance  of  the  wall  and  fullness  of  the  arteries 
should  be  proportionate  to  each  other,  and  is  so  in  normal 
cases  ;  but  this  parallelism  is  frequently  interrupted.  (See 
especially  No.  IV.) 

How  is  this  rhythmic  wave  to  be  explained  ? 

The  increased  pressure  must  depend  on  one  of  three 
things :  increased  energy  of  the  cardiac  systole  ;  obstacle  to 
the  free  egress  of  blood  from  the  arteries  ;  or  finally,  increase 
in  the  mass  of  the  circulating  fluid. 

Now  the  force  of  the  cardiac  systole  is  certainly  increased 
whenever  the  line  of  ascent  in  the  sphygmographic  trace  is 
heightened,  as  it  is  in  all  our  cases.  When  this  heightening 
was  excessive,  we  found  in  one  case  that  the  heart  beat  more 
frequently  (No.  I,  December  30) — 100  a  minute.  But  in 
No.  VII  the  frequency  of  the  pulse  was  increased  without 
producing  this  remarkably  high  vertical  line  of  ascent. 

If,  however,  the  energetic  cardiac  systole  existed  alone, 
the  line  of  ascent  would  be  followed  by  a  peaked  summit 
and  abrupt  line  of  descent,  as  in  the  first  menstrual  trace  of 
No.  I,  December  30.  Again,  any  hindrance  suddenly  offered 
to'the  egress  of  blood  from  the  arteries  should  produce  such 
a  trace  as  we  have  in  No.  VII,  January  7,  when  menstrua- 
tion was  prematurely  checked.  But  it  is  evident  from  this 
trace  that  the  resistance  is  increased  more  than  the  internal 
pressure ;  whereas  in  our  premenstrual  traces,  the  pressure 


l6o  TI-IK    QUESTION    OF    REST    FOR    WOMEN. 

is  always  increased  more  than  the  resistance.  We  are  then 
obliged  to  refer  to  the  third  condition  of  increased  tension, 
namely,  an  increase  in  the  mass  of  the  circulating  fluid.  In 
perfectly  normal  cases  the  tonicity  of  the  arterial  wall  is 
increased  pari passn  with  the  increase  of  pressure.  It  is  pre- 
cisely where  this  is  not  the  case  that  the  rise  of  tension  is 
accompanied  by  symptoms  of  general  nervous  disturbance, 
plainly  to  be  referred  to  the  pressure  sustained  by  the  vessels 
in  the  nerve  centres  and  not  adequately  resisted. 

How  may  we  explain  the  fact,  (noticed  under  third)  that 
the  arterial  tension  is  sometimes  higher  six  or  seven  days 
before  menstruation  than  it  is  on  the  day  or  two  immediately 
preceding  ? 

If  we  refer  to  the  descriptions  of  the  uterus  on  the  day 
just  before  menstruation,  given  pp.  93  and  95,  we  shall  see 
that  it  is  just  at  this  time  that  blood  begins  to  flew  towards 
the  pelvic  vessels,  and  the  uter-ovarian  plexus,  and  a  slight 
diversion  is  therefore  effected  from  the  mass  of  blood  circu- 
lating in  the  upper  half  of  the  body,  which  should  be  ex- 
pected to  somewhat  lower  the  tension  in  the  radial  artery. 
In  the  first  month  of  pregnancy  the  same  effect  would  prob- 
ably be  produced  in  the  sphygmographic  trace  of  this  artery 
from  a  similar  cause.  For  during  this  month,  the  woman 
often  suffers  from  cerebral  anaemia,  as  indicated  by  giddiness 
upon  assuming  an  erect  position,  giddiness  quite  relieved  by 
lying  down,  and  the  amount  of  urine,  (not  merely  the  fre- 
quency of  its  evacuation)  is  greatly  increased.  We  have  not 
yet  positively  proved  that  this  diuresis  is  unaccompanied  by 
an  increase  in  the  excretion  of  urea,  such  as  exists  in  the 
latter  months  of  pregnancy,  but  from  the  limpid  appearance 
of  the  urine  we  believe  (subject  to  correction,)  that  it  is  inde- 
pendent of  any  such  increased  movement  of  nutrition  as 
would  be  then  implied,  and  due  simply  to  an  increased  circu- 
lation in  the  abdominal  and  pelvic  blood  vessels. 

In  the  later  months  of  pregnancy,  at  the  same  time  that 


MENSTRUATION   AND   PREGNANCY.  l6l 

the  excretion  of  urea  is  increased,  a  high  tension  has  been 
observed  in  the  sphygmographic  trace.1  This  has  been  ex- 
plained by  the  increased  mass  of  blood,  the  hypertrophied 
heart,  the  additional  pressure  on  the  kidneys  from  extra 
excretion  of  effete  matter,  finally  by  a  functional  increase  of 
nerve  force.  Our  observations  if  confirmed  by  others  more 
^numerous,  should  show  that  in  all  these  respects  the  inter- 
menstrual,  and  especially  the  premenstrual  period,  represents  a 
pregnancy  in  miniature? 

In  the  investigation  of  these  waves  of  nutrition,  the  great- 
est assistance  should  be  afforded  by  the  measurement  of  the 
blood  corpuscles,  according  to  the  new  method  introduced 
by  Potain  and  Malassez.3  We  should  expect  to  find  a  gradual 
increase  in  the  number  of  blood  corpuscles  from  the  mini- 
mum point,  immediately  after  the  menstrual  hemorrhage,  to 
a  maximum  just  before.  It  is  only  by  such  a  complete  series 
of  measurements  that  any  valuable  result  can  be  obtained. 
To  ascertain,  as  we  believe  has  been,4  that  the  blood  corpus- 
cles are  decreased  immediately  after  menstruation,  is  per- 
fectly useless  until  it  has  been  shown  whether  any  provision 
has  been  made  for  this  physiological  diminution,  by  a  cor- 
responding increase  immediately  before. 

Circumstances  beyond  our  control,  have  hitherto  pre- 
vented us  from  pursuing  this  research,  which  we  propose  to 
do  later.  Setting  this  aside,  we  may  sum  up  the  results  de- 

1  Fancourt  Obstet.  Trans,  vol.  xvi.  p.  263. 

2  Several  writers  admit  an  increased  tension  in  blood  vessels  just  before  men- 
struation, as  a  consequence  of  "  ovarian  irritation."     This  could  only  act  by  vaso- 
motor  spasm,  and  hence  hindrance  to  the  egress  of  blood.     But  the  subjective 
phenomena  which  accompany  an  "irritative  rise  of  tension,"  are  entirely  differ- 
ent from  those  exhibited  with  these  rhythmic  traces. 

3  Archives  de  Physiologic,  1873.     See  the  application   of  this  method,  Wil- 
boucliewitch,  in  Archives  de  Physiol.  1873,  and  by  Keys  Am.  Journ.  Med.  Science, 
Jan. 1876. 

4  We  have  not  by  us  at  this  moment  the  memoir  of  Malassez,  but  we  think  he 
mentions  this  experiment  among  his  others,  Archives  de  Physiologic,  1874. 

II 


1 62  THE   QUESTION   OF   REST    FOR   WOMEN. 

rived  from  the  foregoing  observations  on  the  excretion  of 
urea,  on  the  pulse  and  temperature,  and  finally  on  the  sphyg- 
mographic  trace  of  menstruating  women  during  the  different 
periods  of  the  month.  We  find  that  in  the  majority  of  cases, 
the  excretion  of  urea  is  increased  during  the  few  days  pre- 
ceding menstruation,  over  that  of  the  intermenstrual  period; 
that  it  decreases  during  the  menstrual  flow,  and  is  at  its  min- 
imum just  afterwards  ;  that  the  pulse  shows  no  uniform  rate 
of  variation,  but  that  the  temperature  rises  just  before  men- 
struation, to  fall  during  the  flow,  but  at  this  time  rarely 
reaching  the  point  of  the  intermenstrual  period.  Finally  that 
the  sphygmographic  trace  shows  a  constantly  increasing  rise 
of  arterial  tension  from  a  minimum  point  reached  just  after 
menstruation  to  a  maximum  point  just  before,  but  rapidly 
lessened  during  the  menstrual  flow. 

From  our  tables  as  well  as  from  the  experiments  made  by 
many  others,1  it  is  certain  that  increased  nervous  action  de- 
termines an  increase  in  the  excretion,  and  probably  in  the 
production  of  urea.  It  is  important  for  our  purpose,  how- 
ever, to  remember  that  an  increase  in  the  number  of  the  blood 
corpuscles  has  the  same  effect.  Thus  men  in  whose  blood  is 
a  larger  number  of  blood  corpuscles,  habitually  excrete  a 
larger  amount  of  urea  than  women. 

\Yhatever  the  ultimate  cause,  however,  it  is  unquestionable 
that  this  phenomenon  always  implies  an  increased  movement 
of  disassimilation  and  oxidation  of  albuminous  tissues, 
principally  of  the  nervous  and  muscular.  This  may  exist 
alone,  as  in  diabetes  or  in  fever,  but  when  accompanied  by 
good  health  and  increased  vigor,  certainly  presupposes  a  pre- 
vious increase  in  the  rate  of  assimilation,  that  is  of  nutrition. 

Now  in  the  majority  of  women,  the  week  preceding  men- 
struation is  a  period  of  increased  vigor,  consciousness  of  in- 
creased nervo-muscular  strength.2  We  are  therefore  justified 

1  Neubauer  and  Vogel,  Analyse  des  Harnes. 

3  The  cases  where  the  contrary  is  observed  will  be  considered  later. 


VARIATIONS   OF   UREA.  163 

in  assuming  that  the  increased  excretion  of  urea  observed  in 
the  majority  of  cases  at  the  premenstrual  period,  implies  an 
increased  movement  of  nutrition,  although  not  very  marked. 

When  the  urea  continues  to  increase  during  the  men- 
strual period,  it  is  probably  due  to  other  causes,  perhaps  to 
the  nervous  irritation  which  in  many  cases  accompanies 
menstruation. 

The  diminution  of  urea  during  the  flow,  is  susceptible  of 
three  interpretations  ;  either  the  general  nutritive  movement 
of  assimilation  and  disassimilation  has  decreased,  or  the  urea 
in  the  blood  has  been  carried  off  by  the  menstrual  hemor- 
rhage j1  or  finally  the  assimilation  of  albuminous  substances 
from  the  blood  is  diminished,  so  that  these  pass  off  in  the 
shape  of  the  albuminoid  constituents  of  the  menstrual  blood. 
The  first  is  the  opinion  of  Rabuteau,  who,  as  we  have  seen, 
explains  the  decrease  by  the  loss  of  the  red  corpuscles  needed 
for  the  oxidation.  As  only  five  or  six  ounces  of  blood  are 
lost  during  menstruation,  and  the  proportion  of  urea  in  the 
normal  blood  is  almost  imperceptible,  (one  gramme  in  the 
entire  body)  it  is  improbable  that  the  amount  of  urea  defi- 
cient could  be  excreted  as  such  in  the  menstrual  blood,  whose 
composition  is  the  same  as  that  circulating  in  the  veins.  We 
acgept  therefore,  the  first  or  third  explanations,  probably 
both.2  The  slackening  of  the  movement  of  nutrition  in 
nerves  and  muscles,  is  in  strict  correlation  with  the  loss  of 
oxidizing  corpuscles  by  the  hemorrhage.  Finally  the  diminu- 

1  In  the  ultimate  stages  of  renal  cirrhosis,  when  the  excretion  of  urea  by  the 
kidneys  has  become  almost  impossible,  intestinal  hemorrhage  not  unfrequently 
occurs,  and  compensates  the  suppression  of  the  normal  evacuation.  \Ve  have 
recently  seen  such  a  case  in  our  own  practice,  and  where  an  extensive  ulceration 
developed  around  the  anus  which  we  ascribed  to  irritation  of  ammonia  derived 
from  the  urea  presumably  contained  in  the  blood.  At  the  autopsy,  no  visceral 
disease  was  found,  except  the  most  extensive  cirrhosis  of  the  kidneys,  and  super- 
ficial ulceration  of  the  large  intestine. 

*  The  relative  analysis  of  blood  for  albumine  would  be  as  desirable  as  for  blood 
corpuscles,  but  much  more  difficult  to  obtain. 


164  THE    QUESTION    OF    REST    FOR    WOMEN. 

tion  of  urea  during  the  days  following  menstruation,  at  first 
sight  appears  to  be  analogous  to  that  observed  after  patho- 
logical hemorrhage.  In  the  latter  case,  however,  the  patient 
always  suffers  from  a  feeling  of  exhaustion,  just  as  indeed,  do 
certain  persons  after  menstruation,  whether  this  be  excessive 
or  apparently  normal  in  quantity.  But  usually,  as  Bischoff 
long  ago  insisted,  women  feel  very  well  at  this  time,  fact  en- 
tirely incompatible  with  the  supposition  that  nervo-muscu- 
lar  nutrition  has  been  depressed  below  its  normal  level.  We 
must  rather  infer  that  the  depression  is  relative,  and  shows 
a  decrease  from  a  temporary  elevation. 

The  rise  in  temperature  indicates  the  same  curve  of  oxi- 
dations as  the  alterations  in  the  amount  of  urea,  and  again, 
we  are  led  to  suspect  as  a  probable  proximate  cause,  an  in- 
crease in  the  number  of  blood  corpuscles. 

Finally  the  rise  of  the  tension  as  indicated  by  the  sphyg- 
mographic  trace,  seems  to  intimate,  for  the  reasons  above 
given,  an  increase  in  the  mass  of  the  circulating  fluid. 

In  all  the  details  examined  therefore,  we  find  evidences 
of  such  a  gradual  but  steady  preparation  for  the  menstrual 
hemorrhage,  as  should  exclude  the  idea  that  this,  when  nor- 
mal, has  any  tendency  to  deplete  the  nutrition  or  lower  the 
strength.  It  is  to  be  regarded  as  the  simple  equivalent  of 
an  accumulation  effected  by  a  constantly  rising  wave  of 
nutrition,  primarily,  (in  all  probability)  affecting  the  blood, 
but  secondarily,  and  as  a  result  incidental  to  the  main  object 
of  the  wave,  affecting  the  nervous  and  muscular  system 
through  which  that  blood  circulates.  The  blood  of  the 
woman,  non-pregnant  as  well  as  pregnant,  maintains  constant 
provision  for  tJie  nutrition  of  offspring,  just  as  the  sap  of  the 
tree  contains  constant  provision  for  the  nutrition  of  buds. 

The  special  variations  of  this  blood,  i.  c.  as  regards  sex, 
are  all  relative  to  this  circumstance,  but  incidentally,  the 
nutrition  of  the  woman's  own  organs  is  effected. 

If  richer  blood  circulates  in  a  slightly  increased  quantity. 


RHYTHMIC   REPRODUCTION.  165 

and  under  a  higher  pressure,  through  the  nervo-muscular 
organs,  the  nutritive  movements  in  their  tissues  are  acceler- 
ated, and  the  acceleration  is  marked  by  the  increase  of  urea. 
When,  in  virtue  of  the  rhythmic  movement  inherent  in  their 
form  of  nutrition,  a  portion  of  the  nutritive  fluids  of  women 
becomes  in  excess  of  their  individual  needs,  this  excess  be- 
gins to  accumulate  in  the  circulation,  until  finally,  the  tension 
becoming  excessive,  the  closed  system  gives  way  at  its  weak- 
est point,  the  blood  vessels  of  the  fattily  degenerated  uterine 
decidua,  and  hemorrhage  occurs.1 

From  all  this  it  should  follow  that  reproduction  in  the 
human  female  is  not  intermittent,  but  incessant,  not  periodical, 
but  rhythmic,  not  dependent  on  the  volitions  of  animal  life,  but 
as  involuntary  and  inevitable  as  are  all  the  phenomena  of 
nutritive  life.  Vulpian,  (Physiol.  de  1'amnios  et  de  1'allantois. 
J.  Br.  Sequard,  V.  i.  p.  6 1 6,)  remarks  that  the  allantois  of  the 
chicken  shows  rhythmic  contractions  from  the  eighth  day, 
and  the  amnios  from  the  sixth  or  seventh,  at  a  time  when 
no  nerve  elements  exist  in  trfe  amnios,  so  that  its  rhythmic 
action  cannot  be  dependent  on  periodical  nervous  influence. 
The  author  questions  whether  the  movement  can  be  attrib- 
uted to  alternate  modes  in  the  nutrition  of  the  blood.  He  is 
prepared  to  admit  that  the  rhythmic  type  is  general  to  the 
movement  of  nutrition. 

In  animals,  many  nutritive  phenomena,  essentially  the 
same  as  those  of  plants,  appear  to  change  their  character, 

1  Leigois  ridicules  the  "  plethoric  "  theory  of  menstruation  on  ihe  ground  that 
woman's  blood  has  been  shown  to  be  habitually  anemic  relative  to  man's,  *'.  e.  to 
have  fewer  blood  corpuscles  than  msn's.  From  what  precedes  it  is  evident  that 
no  measure  of  blood  corpuscles  is  of  value,  unless  repeated  thioughout  the  month. 
Moreover,  even  were  an  absolute  inferiority  proved,  we  should  attribute  it  to  the 
absolute  inferiority  of  muscle  needing  less  oxidation.  "  There  is,"  observes 
Paget.  loc.  cit.  p.  II,  "  no  fixed  standard  to  the  composition  of  the  blood.  From 
birth  onwards  the  blood  and  tissues  of  each  creature  are  adapted  to  one  another, 
and  the  maintenance  of  health  depends  on  the  maintenance  of  their  mutual 
reactions." 


1 66  THE   QUESTION   OF    REST    FOR    WOMEN. 

because  in  their  complete  evolution  the  functions  of  animal 
life,  especially  voluntary  movement,  have  intervened.  Thus 
in  the  two  great  departments  of  nutrition,  the  primary  and 
the  ultimate,  absorption  of  food,  and  reproduction  of  the 
individual,  the  movements  that  in  plants  depend  upon  ex- 
ternal agencies,  in  animals  depend  on  the  individual  volition. 
Currents  of  air  being  food  to  the  plant,  currents  of  water 
being  food  to  the  mollusk,  which  in  its  immobility  resembles 
an  important  character  of  plants  ;  but  the  animal  must  go  in 
search  of  its  fodder  or  prey.1 

These  remarks  are  not  irrelevant,  because  of  the  wide- 
spread though  unconscious  perversion  of  view  that  has  re- 
sulted from  the  habit  of  associating  menstruation  with  the 
sexual  instead  of  the  reproductive  functions  of  women;  and 
of  expecting  it  to  be  accompanied  by  some  especial  excite- 
ment of  the  cerebro-spinal  nervous  system,  such  as  must 
necessarily  hold  in  abeyance  all  other  activity  of  the  central 
nervous  organs. 

The  suggestion  so  frequently  made  (see  former  quota- 
tions), that  by  means  of  menstruation  celibate  women  were 
enabled,  to  a  certain  extent,  to  compensate  their  celibacy, 
rests  upon  the  slenderest  foundations.  But  WTC  should  assert 

1  Nevertheless  the  voluntary  movements  of  the  animal  are  ultimately  depend- 
ent upon  rhythmic  waves  of  excitation  in  the  masses  of  nerve  matter  where  they 
originate.  Food  is  brought  to  the  ganglion  cells  by  the  blood  currents,  as  pas- 
sively as  to  the  oyster  by  the  water  currents.  "  Let  us  remember,"  observes 
"NVandt,  "  that  slight  excitations  generally  vanish  in  the  central  substance  of  the 
cell,  while  stronger  excitations  set  free  its  latent  force.  The  excitation  of  the 
blood  current  impinging  on  the  periphery  of  the  cell  must  accumulate  until  they 
reach  a  given  strength,  sufficient  to  liberate  the  force  of  the  cell,  which  is  then 
transmitted  to  its  central  region,  and  thence  to  its  motor  nerve.  After  this  dis- 
charge of  force,  equilibrium  is  restored,  and  the  process  begins  all  over  again. 
Nerve  centres  submitted  exclusively  to  the  excitation  of  the  blood  act  automati- 
cally and  rhythmically.  .  .  .  This  rhythm  is  interrupted  or  rendered  irregulai 
when  the  influence  of  other  nerve  centres  inhibits  the  discharge  of  accumulated 
force."  (Untersuch.  zur  Mechanik  der  Nerven.  1876.) 


CONTINUITY   OF   REPRODUCTION.  1 67 

that  the  menstrual  process,  peculiar1  to  the  one  class  of 
animals  who  are  capable  of  avoiding  or  of  missing  an  oppor- 
tunity to  propagate  their  species,  indicates  that  this  freedom 
of  choice  is  only  superficial  or  apparent,  and  that  the  initial 
steps  of  reproduction  are  being  constantly,  not  periodically, 
taken  by  the  force  of  nature,  working  independent  of  human 
will  or  of  social  accident.  The  woman  buds  as  surely  and  as 
incessantly  as  the  plant,  continually  generating  not  only  the 
reproductive  cell,  but  the  nutritive  material  without  which 
this  would  be  useless,  whether  or  no  either  be  utilized  in 
further  development.  Whence  is  this  nutritive  material 
obtained  ? 

1  Notwithstanding  Pouchet.  It  would  bring  us  too  far  from  our  subject  to 
discuss  the  vexed  questions  of  this  peculiarity.  It  is  difficult  to  understand  that 
a  provision  for  the  nutrition  of  an  embryo  in  one  mammalian  animal  should  not 
be  required  in  all.  Pouchet's  opinion,  that  in  many  animals  the  same  propor- 
tionate amount  of  blood  is  diverted  to  the  pelvic  organs  during  the  rut,  but  that 
those  being  looser  in  texture  are  able  to  retain  it  without  evacuation,  seems  ex- 
tremely probable.  Moreover,  if  in  animals  every  rutting  season  is  intended  to 
be  followed  by  a  conception,  the  habit  of  evacuation  of  the  provisional  nutriment 
would  never  be  established. 


SECTION   V. 

THEORY    OF    SUPPLEMENTAL    NUTRITION. 

THIS  certainly  does  not  come  from  extra  nourishment, 
for  women  eat  less  than  men,  and  female  animals  and 
female  plants  eat  no  more.  It  must  therefore  be  derived 
from  a  reserve  drawn  from  the  ordinary  nutritive  supply  of 
the  body,  and  it  is  the  possibility  of  making  this  reserve 
which  constitutes  the  essential  peculiarity  of  the  female  sex.1 
Spencer's  generalization,  already  made  by  Haller,  that 
reproduction  is  only  possible  when  growth  ceases,  affords  no 
explanation  of  the  differences  between  the  sexes  which  physi- 
cally are  so  much  more  marked  in  human  beings  than  in  the 
lower  animals.  His  further  proposition,  that  in  women  indi- 
vidual development  must  be  arrested  on  a  lower  type  than 
that  of  men,  in  order  to  leave  a  margin  for  reproduction,  is 
useless,  and  even  untrue,  on  account  of  the  width  of  the 
generalization.  Nevertheless,  in  view  of  the  primitive  equal- 
ity or  even  identity  of  the  sexes,2  this  margin  must  exist,  the 
reserve  must  be  drawn  from  somewhere  in  the  sex  which 
sustains  the  greatest  cost  of  reproduction  ;  and  as  the  most 
obvious  difference  between  the  sexes  consists  in  the  amount 
of  motor  force  possessed  by  each,  and  in  the  development  of 
the  motor  apparatus,  the  muscles  and  the  bones,  the  nutri- 

1  Even  if  it  were  admitted  with  Hermann,  that  the  ordinary  cost  of  reproduc- 
tion is  the  same  in  both  sexes  (see  pp.  12  and  173),  this  would  no  longer  hold 
during  gestation.  For  this,  an  organic  habit  of  nutrition  must  be  provided,  quite 
peculiar  to  the  female. 

1  Embryologically  and  to  a  less  extent  during  childhood. 


LOCOMOTOR   APPARATUS   OF   WOMEN.  169 

tive  margin  theoretically  admitted,  has  often  been  derived 
from  this  apparatus. 

This  entire  locomotor  apparatus  is  much  more  developed 
in  men  than  in  women.  The  muscles  are  more  massive  even 
relatively  to  the  size  of  the  body,  and  the  body  in  all  male 
animals  above  fishes  is  larger.  "  If  it  be  asked  why  girls 
arrive  at  puberty  earlier  than  boys,  we  reply  that  as  men  are 
much  larger  and  stronger  than  women,  as  they  have  the  body 
more  solid,  more  massive,  the  bones  harder,  the  muscles  more 
firm,  we  should  expect  that  the  time  needed  for  the  growth 
of  their  body  would  be  larger  than  that  necessary  for  women  ; 
and  as  it  can  only  be  after  the  completion  of  growth,  that  the 
surplus  of  organic  nourishment  begins  to  be  sent  from  all  the 
parts  of  the  body  to  the  organs  of  generation,  it  happens  that 
in  women  the  nourishment  is  sent  there  sooner,  because  their 
growth  is  sooner  completed.1  The  development  of  the  bones 
is  the  consequence,  not  the  cause  of  the  development  of  the 
muscles,  formed  earlier,  and  of  superior  physiological  signifi- 
cance; size  is  added  to  motor  force,  not  motor  force  to  size. 
Comparison  between  the  nervous  apparatus  of  the  two  sexes, 
though  often  made,  is  by  no  means  so  easy.  We  may,  how- 
ever, consider  the  following  facts  to  be  proved,  i.  That  the 
structural  development  and  functional  activity  of  the  central 
nervous  organs,  is  by  no  means  in  proportion,  inverse  or 
direct  to  their  mass. 

2.  That  this  mass,  especially  as  considered  in  the  white 
substance,  is  proportioned   to  the  degree  of  muscular  de- 
velopment. 

3.  That  the  bony  cases  containing   the  central  nervous 
organs,  although  in  their  growth  closely  following  that  of 
their  contents,  are  nevertheless,  in  their  outer  aspect  in  the, 
development    of  their    prominences,    rugosities,  apophyses, 
closely  related  to  the  development  of  the  muscular  system. 

1  Buffon,  Hist.  Naturelle  de  I'homme.  Quoted  by  Quetelet,  Anthropometrie, 
p.  201. 


I/O  THE   QUESTION   OF   REST    FOR   WOMEN. 

These  characters  even  appear  on  fossil  skulls/  whose  sex  is 
(presumably)  easy  to  distinguish  by  them. 

4.  To  these  propositions,  generally  admitted,  may  be  per- 
haps added  a  fourth  based  upon  less  certain  data.  The  local- 
ization in  the  anterior  lobes  of  the  cerebral  hemispheres,  of 
ideo  motor  centres,2  tends  to  attribute  if  proved,3  the  prepond- 
erance of  this  portion  of  the  brain  in  men,  as  compared 
with  women,  at  least  in  part  to  the  preponderance  in  them 
of  muscular  strength  and  motor  force.4  Whether  or  no  the 
ideo  motor  centres  of  the  convolutions  be  admitted,  it  is  indis- 
putable that  the  largest  and  most  exclusively  motor  tract  of 
nerve  fibres,  that  which  is  carried  up  in  the  foot  of  the 
peduncles,  terminates  entirely  in  the  anterior  province  of  the 
brain,  namely  in  the  cortex  of  the  cerebral  hemispheres,  in 
the  corpora  striata,  and  in  the  extra  ventricular  nucleus. 
(Huguenin,  \Vundt.) 

From  all  these  circumstances  we  may  at  least  presume, 
that  any  general  inferiority  in  the  entire  mass  of  the  central 
nervous  organs  in  women,  as  compared  with  those  of  men, 
(out  of  proportion  to  the  smaller  size  of  the  body  of  course) 
principally  relates  to  the  organs  of  motility,  the  anatomical 
conditions  of  sensibility  and  of  thought  remaining  the  same. 
This  fact  leaves  much  room  for  variation  in  the  dynamical 
conditions.  Further,  that  while  the  mass  of  these  central 
organs  of  motility  is  permanently  less,  we  have  no  facts 
which  prove  an  equally  necessary  inferiority  in  the  elabora- 
tion of  their  structure. 

This  distinction  is  extremely  important,  for  if,  owing  to 
the  smaller  mass  of  muscle,  the  woman  requires  less  quantum 

1  Quatrefages  et  de  Hamy,  Crania  Ethnica,  1873. 

9  Hitzig,  Untersuch  ueber  das  Gehirn,  1874.  Wundt,  Physiologischen  Psychol- 
ogic. Dalton,  Report  of  Committee  of  X.  Y.  Society  of  Neurology,  1875.  Ferrier, 
Functions  of  the  Brain,  1876. 

3  It    is  vigorously  disputed  by  Dupuy,  These  de  Paris,  1873,  and  denied  by 
Hermann. 

4  The-  exact  relative   proportions  between  different  parts  of  the  brain  in  the 
two  sexes,  is  by  no  means  completely  determined. 


RELATION   BETWEEN   MUSCLES   AND   REPRODUCTION.      I/ 1 

of  nerve  force  to  be  generated  in  the  motor  centres,  yet  the 
tonus  of  each  individual  fibre  is  as  important  for  her  as  for 
the  man,  and  hence  there  is  as  much  demand  for  the  power 
to  generate  force  in  each  nerve  cell;  in  other  words,  for  as 
fine  a  structure  of  the  nerve  centres. 

That  this  power  is  frequently  deficient  in  women,  that  to 
it  is  due  the  major  part  of  both  their  inefficiencies  and  ail- 
ments, is  unquestionable,  but  there  is  nothing  to  show  that 
such  deficiency  is  either  a  primary  or  secondary  sexual 
characteristic. 

Of  all  the  tissues,  therefore,  it  is  the  muscular,  to  which 
the  bones  and  probably  certain  portions  of  the  nervous  sys- 
tem are  accessory  or  correlative,  that  exhibits  the  greatest 
difference  in  the  quantum  of  development  in  the  two  sexes. 
These  differences  are  most  marked  in  the  human  race,  and 
increasingly  so  in  proportion  to  the  luxury  of  civilization  ; 
but  they  exist,  at  least  the  preponderance  of  size  exists,  in 
the  larger  number  of  the  vertebrated  animals  above  fishes. 

Again,  these  differences  are  not  sensibly  perceptible  until 
the  approach  of  puberty,  children  under  ten  years  of  age 
being,  if  submitted  to  the  same  regime  of  exercise,  about 
equal  in  muscular  force  and  development.  We  are,  there- 
fore, almost  forced  to  the  conclusion  that  "  the  arrest  of  indi- 
vidual development "  which  marks  the  unfolding  of  repro- 
ductive powers  in  the  girl,  does  not  take  place  in  her  entire 
body,1  but  in  her  locomotor  system,  including  all  the  organs 
comprised  in  it,  muscles,  bones,  and  nerves,  or  motor  nerve 
centres.  This  arrest  implies  that  at  this  epoch  the  muscles 
begin  to  refuse  to  assimilate  a  certain  proportion  out  of  each 
group  of  nutritive  molecules  which  is  brought  to  them  by 
the  circulation.  They  cannot  refuse  all,  for  then  their  waste 
would  not  be  repaired,  and  they  would  atrophy.  Nor  can  it 
be  said  that  the  amount  of  nutriment  brought  to  the  muscles 

1  The  question  of  arrest  of  mental  development  is  foreign  to  our  subject, 
except  as  implied  in  the  question  of  development  of  nerve  centres. 


\J2  THE   QUESTION   OF    REST    FOR   WOMEN. 

merely  remains  the  same  as  it  had  been  during  childhood. 
If  the  amount  and  distribution  of  nutrition  did  remain  the 
same,  the  body  must  necessarily  remain  in  the  same  condi- 
tion, permanently  childish,  incapable  of  reproduction.  This 
presumption  is  realized  in  certain  idiots  and  cretins.  Now 
the  amount  of  food  taken  by  boys  at  puberty  does  increase, 
and  they  continue  to  gro\v,  while  girls,  even  in  full  health, 
hardly  eat  any  more  at  sixteen  than  at  ten,  and  their  growth 
usually  ceases.  The  amount  of  nutriment,  therefore,  is  pro- 
portioned to  the  growth  of  the  individual,  and  approximately, 
to  the  bulk  of  the  muscular  osseous  system.1  The  only 
change  possible  in  order  to  secure  a  margin  of  nutrition  for 
reproduction,  must  be  in  the  distribution  of  nutriment. 
Since  this  margin  is  required  in  both  sexes,  the  change  in 
distribution  is  required  in  both,  and  is  effected  throughout 
the  entire  animal  as  well  as  vegetable  creation,  by  means  of 
an  arrest  of  individual  growth.  The  difference  in  this,  respect 
between  the  two  sexes,  is  a  difference  not  of  kind,  but  of 
degree.  It  is  a  difference  not  explained,  as  has  been  foolishly 
asserted,  by  the  presence  in  the  female  of  more  highly  devel- 
oped organs  of  generation,  since  they  are  exactly  balanced 
in  the  two  sexes."  An  excess  of  bulk  in  one  direction  is 
compensated  by  an  inferiority  in  another,  so  that  the  sum 
total  is  the  same.  Hence  here  is  no  reason  for  arresting 
muscular  development  in  the  woman  earlier  than  in  the  man. 
Again,  any  extra  nutrition  demanded  by  the  increase  of  size 
in  the  uterus  and  ovaries  at  puberty,  is  much  too  trifling  to 
necessitate  any  important  change  in  the  nutrition  of  other 
organs.  It  could  not  be  a  cause  of  change  in  the  distribution 
of  nutrition,  because  nutritive  currents  have  been  from  birth 
directed  to  the  same  organs,  and,  for  several  years  before 

1  Of  course  mere  size,  depending  on  fat,  is  excluded  from  consideration. 

*  The  details  of  these  analogies  are  so  familiar  to  anatomists  that  it  would  he 
useless  to  refer  to  them,  were  it  not  for  the  extraordinary  statements  that  have 
been  made  concerning  the  preponderance  of  such  organs  in  woman.  See  Flour- 
ens,  Cours  d"  Embryologie. 


PHYSIOLOGICAL   CHANGES   AT   PUBERTY.  1/3 

puberty,   in  almost  as  great  abundance  as  after  its  estab- 
lishment. 

The  demand  for  an  altered  distribution  of  nutrition  is  not 
in  relation  to  new  organs,  but  to  a  new  function,  or  it 
refers  not  to  special  anatomical  tissues,  but  to  physiological 
processes  in  which  all  tissues  share.  The  difference  in  the 
degree  of  the  demand,  or  the  cost  of  reproduction  in  the  two 
sexes,  is  partly  indicated  by  the  different  degrees  in  which 
the  individual  nutrition  is  altered.  The  difference  for  the 
cost  of  the  processes  actually  instituted  is  not  so  great.  In 
the  woman  the  extra  development  of  the  germ  cell  is  com- 
paratively trifling,  the  amount  of  nutritive  fluid  (as  repre- 
sented by  the  menstrual  blood)  more  abundant.  In  the  other 
sex,  the  analogous  nutritive  fluid  is  much  less  in  quantity,  but 
on  the  other  hand,  the  germ  cells  begin  to  be  formed  at 
puberty,  and  if  smaller  in  size,  are  more  numerous  than  the 
ova.  In  the  woman  it  is  the  potential  cost  of  reproduction 
which  is  in  such  immense  excess.  Ovulation  and  menstruation 
do  not  represent,  as  do  the  corresponding  processes  in  the 
man,  the  entire  contribution  of  the  organism,  to  reproduction  ; 
they  only  sketch  out  the  work  that  is  to  be  accomplished  by 
it  in  pregnancy.  It  is  for  this  especially  that  a  new  habit  of 
nutrition  of  the  entire  body  is  required,  and  it  is  instituted 
in  advance,  just  as  the  habit  of  breathing  with  the  upper  part 
of  the  thorax  is  begun,  a  habit  useless  except  in  pregnancy. 
Were  it  merely  necessary  to  provide  an  amount  of  nutriment 
corresponding  to  what  is  contained  in  the  ovule,  and  the  five 
or  six  ounces  of  blood  lost  in  the  monthly  hemorrhage,  or 
were  menstruation  constant,  i.  e.  a  physiological  phenomenon 
of  short  intermittence  like  digestion,  it  is  conceivable  that 
this  should  have  been  done  in  the  one  sex  as  in  the  other, 
by  means  of  an  extra  amount  of  food,  and  by  the  arrest  of 
growth  after  that  had  reached  a  higher  degree  of  develop- 
ment. Instead  of  this,  the  cost  of  reproduction  in  its  initial 
stage,  is  provided  for  by  the  same  mechanism  which  will  be- 


174  THE    QUESTION   OF    REST    FOR   WOMEN. 

come  necessary  in  a  later  stage.  The  amount  of  nutriment 
is  not  increased,  but  a  portion  of  it  is  diverted  into  new  chan- 
nels. The  organs  from  which  it  is  so  diverted,  can  be  no- 
other  than  those  which  cease  to  develop  in  bulk  and  func- 
tional power,  not  only  absolutely  but  relatively  to  the  rest  of 
the  body,  and  fall  below  the  typical  possibility  of  the  race  as 
exhibited  in  men.  The  only  organs  in  -which  such  changes 
are  evident  are  the  muscles,  and  their  accessories  the  bones. 

If  the  first  establishment  of  menstruation  is  correlative  to 
a  diminution  of  muscular  nutrition,  we  are  already  justified 
in  looking  in  this  same  direction  for  the  provision  that  we 
should  expect  to  be  made  for  its  continuance.  It  is  almost 
an  axiom  in  physiology,  that  the  entire  interval  between  the 
recurrences  of  a  rhythmically  intermittent  process,  is  occu- 
pied by  preparation  for  that  process.  The  longer  the  interval, 
therefore,  the  more  salient  must  become  the  marks  of  pre- 
paration. In  the  case  in  question,  the  interval  is  long  enough 
to  reproduce  in  miniature  at  each  menstrual  period  certain 
conditions  of  the  first  menstruation.  To  carry  out  the  re- 
semblance, we  should  be  able  to  detect  a  gradual  deviation 
from  muscular  nutrition  resulting  in  an  accumulation  in  the 
blood  vessels  of  nutritive  fluid  refused  by  the  muscles,  until 
the  tension  has  been  raised  to  a  maximum  just  before  degen- 
eration of  the  uterine  mucous  membrane  permits  the  blood 
vessels  to  rupture  at  this  point.  There  can  be  no  question 
that  this  series  of  phenomena  occurs  at  puberty.  In  what 
way  could  it  be  repeated  at  succeeding  menstruations  ? 

Two  distinct  series  of  chemical  processes  are  carried  on 
in  muscles,  which,  as  both  concern  molecular  movements  of 
integration  and  disintegration,  maybe  classed  together  under 
the  general  head  of  nutritive.  Only  one,  however,  really 
relates  to  the  nutrition,  i.e.  to  the  development  or  the  repair 
of  waste,  of  the  muscular  fibre  proper.  This  is  the  scries  of 
processes  by  which  is  effected  the  assimilation  of  plastic 
(albuminous)  material.  The  other  series  of  processes  is  con- 


MUSCULAR   FUNCTIONS.  175 

nected  with  the  function  of  the  muscle,  and  though,  by  affect- 
ing the  mass  of  juices  contained  in  the  muscle,  it  modifies 
the  size  or  nutrition  of  the  organ  as  a  whole,  it  is  not  directly 
connected  with  the  assimilation  in  the  fibres  constituting  the 
parenchyma.  It  has  been  demonstrated  that  the  contraction 
of  muscles  during  exertion  is  attended  by  an  increased  ex- 
cretion of  carbonic  acid,  while  the  excretion  of  urea  remains 
the  same.  This  is  positive  proof,  and  is  accepted  as  such  by 
all  physiologists,  that  the  heat  required  for  the  production 
of  motor  force  is  not  derived  from  combustion  of  the  albu- 
minous parenchyma  of  the  muscle,  but  of  the  substances, 
principally  hydrocarbonaceous,  contained  in  its  juices. 
Scruff  compares  these  to  the  coal  contained  in  the  locomo- 
tive, whose  motor  power  is  derived  from  oxidation  of  its  con- 
tents, and  not  of  the  substance  of  its  machinery. 

The  chain  of  phenomena  which  intervene  between  the 
oxidations  in  the  muscular  juices  and  the  contraction  of  the 
muscular  fibre,  is  somewhat  variously  interpreted.  Accord- 
ing to  some  physiologists,  the  lactic,  and  possibly  other  acids, 
formed,  partially  coagulate  the  myosine  of  the  fibre,  which  is 
thus  condensed.  Tetanic  contractions,  and  the  rigor  mortis, 
are  only  an  exaggeration  -of  the  condition  present  in  every 
living  movement  (Hermann,  Brown-Sequard).  According  to 
others,  the  sarcous  elements  move  spontaneously  like  the 
amoeba  under  the  stimulus  of  the  heat,  protruding  in  one 
direction  while  retracting  in  another,  or  the  heat  may  be  said 
to  be  directly  converted  into  molecular  movements  within 
these  sarcous  elements  (Pettigrew ').  However  immediately 
effected,  contraction  of  muscular  fibre  quickens  the  circula- 
tion by  compression  of  the  blood  vessels,  and  the  accelerated 
blood  current  removes  the  products  of  oxidation  accumu- 
lated in  the  muscle,  and  brings  a  fresh  supply  of  oxidizable 
material,  together  with  the  plastic  material  for  the  repair  of 
waste  in  the  fibre.  Thus  the  conditions  of  function  and  the 

1  This  writer  has  explained  but  I  believe  not  originated  this  theory. 


i;6  THE   QUESTION   OF   REST    FOR   WOMEN. 

conditions  of  nutrition  of  this  fibre  are  fulfilled  at  the  same 
time,  provided  the  composition  of  the  blood  be  normal. 
Hence  the  peculiarly  intimate  relation  known  to  'exist  in 
muscles  between  the  activity  of  their  functions  and  the  per- 
fection of  their  nutrition. 

Four  circumstances  may  determine  an  alteration  in  the 
chcmico-vital  processes  sustained  in  muscles.  First,  the  com- 
position of  the  blood  may  be  altered.  Deficiency  of  blood 
corpuscles,  or  anemia,  interferes  with  the  oxidation  of  the 
juices,  hence  with  the  entire  series  of  processes  necessary  for 
muscular  contraction  ;  hence  by  imperfect  contractions  the 
circulation  becomes  sluggish,  oxidized  material  is  not  re- 
moved, but,  accumulating,  causes  the  sensation  of  fatigue, 
which  has  been  proved  experimentally  to  depend  upon  such 
accumulations.  The  same  sluggishness  of  circulation  inter- 
feres with  the  supply  of  plastic  material  so  that  the  nutrition 
of  fibre  suffers  coincidently  with  its  function.  The  clinical 
expression  of  these  phenomena  is  of  very  frequent  occurrence, 
Other  variations  in  the  composition  of  the  blood  would  pro- 
duce analogous  results. 

2.  Diversion  of  the  blood  supply  by  causes  external  to  the 
muscle  has  the  same  double  effect.     The  function  is  inter- 
fered with   first,  so  that  in  the  regular   physiological   deriva- 
tions of  blood  from  the  muscles  to  the  gastro-intestinal  tract, 
Avhich   correspond  to  the  intervals   of  digestion,  (see  p.  106) 
the  activity  of  function  is  alone  affected.     Before  nutrition 
could  be  impaired,  (we  are  speaking  of  normal  conditions,) 
the  blood  wave  returns. 

3.  The  oxidations  of  hydrocarbons  in  muscular  juices,  are 
not  only  utilized  in   the  production   of  motor  force,  but  are 
the  principal  source  of  animal  heat.     Further,  Liebermeister 
has  shown  that  in  all  probability,  the  regulation  of  the  heat 
of  the  body  to  a  fixed  standard,  is  effected  in  the  superficial 
layer  of  muscles  just  underlying  the  skin.     To  the  standard 
of  temperature  existing  here,  the  temperature  of  the  body  is 


MUSCULAR   FUNCTIONS.  177 

conformed  in  spite  of  external  variations,  by  means  of  im- 
pressions made  upon  the  superficial  muscular  or  subcutaneous 
nerves.1  The  chemical  processes  furnishing  motor  force,  are 
therefore  controlled  by  the  same  reflex  innervation  which 
regulates  temperature,  and  may  be  expected  to  vary  like  the 
latter,  sometimes  under  the  same,  sometimes  under  other 
conditions. 

4.  The  assimilative  power  of  the  muscular  fibre  must  be 
presumed  to  vary  like  that  of  all  other  smatomical  elements, 
though  it  must  be  far  from  possessing  the  active  influence  in 
abstracting  assimilable  material,  that  we  have  reason  to  at- 
tribute to  ganglionic  nerve  cells.  The  lesions  which  afford 
positive  proof  that  assimilation  has  diminished  or  ceased, 
the  blood  supply  remaining  the  same,  fatty  and  waxy  de- 
generation, and  simple  atrophy,  have  all  been  traced  to  alter- 
ations in  the  temperature  or  composition  of  the  blood,  to  an 
arrest  of  innervation,  or  to  irritation  of  the  nerve  centre  with 
which  the  muscular  nerve  is  connected.  Apart  from  these 
circumstances,  we  know  of  no  proof  that  the  muscular  fibre  is 
able  to  refuse  to  assimilate  nutriment  that  may  be  brought  to 
it.  Provisionally,  however,  we  may  admit  such  a  possibility. 

Finally,  voluntary  innervation,  determining  voluntary 
muscular  contraction,  has  a  most  powerful  influence  over 
muscular  nutrition,  but  as  it  acts  merely  by  initiating  the 
chemical  processes  already  considered,  its  immediate  effect 
must  be  resolved  into  one  of  them. 

We  may  now  return  to  our  starting  point,  and  inquire 
whether  there  be  any  evidence  that  one  or  more  of  these  pro- 
cesses in  muscles,  are  so  modified,  that  nutritive  material  is 
periodically  accumulated  'in  the  blood  to  meet  the  demands 
of  reproductive  nutrition. 

On  the  most  superficial  view,  the  second  condition  men- 
tioned above  seems  to  be  realized  by  the  derivation  of  blood 
to  the  pelvis,  and  therefore,  presumably,  from  the  muscles 

1  Lehre  des  Fieber,  1876. 
12 


i;8  THE    QUESTION    OF    REST    FOR    WOMEN. 

during  the  menstrual  hemorrhage.  The  alternation  between 
the  circulation  of  the  muscles,  and  of  the  generative  intestine, 
would  be  analogous  to  that  shown  to  exist  between  the  mus- 
cles and  the  digestive  tract.  But  the  analogy  would  fail  in 
one  important  point.  The  blood  diverted  from  the  muscles 
during  digestion,  is  returned  to  them  afterwards,  enriched 
by  fresh  nutriment,  but  the  blood  diverted  during  menstrua- 
tion is  lost.  Unless,  therefore,  a  surplus  had  previously  been 
accumulated  in  the  muscles,  the  hemorrhage,  if  effected  at 
the  expense  of  their  circulation,  must  on  each  occasion  tend 
to  lower  their  nutrition. 

On  the  other  hand,  the  gradual  increase  of  vascular  ten- 
sion during  the  intermenstrual  period,  and  its  maximum  just 
before  the  menstrual  flow,  must,  other  things  being  equal, 
increase  the  nutritive  movement  in  muscular  tissue,  so  long 
as  it  lasts.  This  is  the  first  indication  that  for  a  temporary 
diminution  of  muscular  nutrition  during  the  menstrual  hemor- 
rhage special  provision  is  made,  by  means  of  a  special  increase 
in  this  nutrition  just  before  the  flow. 

So  much  for  the  second  condition  modifying  muscular 
nutrition,  and  its  relations  to  menstruation.  The  fourth  con- 
dition— diminution  in  assimilation  of  plastic  material — exists 
at  puberty,  and  causes  the  arrest  of  muscular  development, 
characteristic  of  that  epoch.  During  menstrual  life,  no  such 
great  change  in  assimilation  could  be  expected  to  take  place, 
nor  docs  it,  but  we  may  mark  lesser  variations  approximately 
by  measuring  the  excretion  of  urea.  In  a  general  way  it 
may  be  said,  that  the  quantity  of  urea  measures  the  quantity 
of  function  performed  by  the  nervous  system,  and  the  quan- 
tity of  nutritive  disassimilation  effected  in  the  muscular.1 
This  proposition  may  be  disputed  by  those  who  assume  that 
a  "waste  of  tissue"  accompanies  all  nervous  action,  and 
measure  that  waste  by  the  urea,  whose  quantity  is  undoubt- 

1  It  docs  not  vary  with  the  functions  of  the  latter,  which  are  measured  by  the 
excretion  of  carbonic  acid. 


UREA   AND   NERVO-MUSCULAR   FUNCTIONS.  1/9 

eclly  increased  by  such  action,  most  demonstrably  by  action 
of  the  brain.  But  we  believe  that  there  is  no  proof. that  the 
functioning  of  nerve  cells  is  necessarily  accompanied  by  dis- 
integration of  their  essential  structural  elements.  We  shall 
return  to  this  point  further  on.  In  the  mean  time,  we  are 
justified  in  resting  upon  the  well  averred  coincidence  between 
increased  brain  function  and  increased  excretion  of  urea,  with- 
out going  behind  it  to  the  hypothesis  of  structural  waste. 
The  fact  itself  is  already  shown  quite  markedly  on  our  tables. 
Apart  from  this  hypothesis,  however,  and  during  equilib- 
rium of  function  in  the  nerve  centres,  it  must  be  admitted 
that  we  have  reason  to  suppose  that  an  increased  movement 
of  disassimilation  in  nervous  tissue  apart  from  increased  func- 
tional activity  must  be  followed,  as  in  muscular  tissue,  by  an 
increased  excretion  of  urea.  The  increase  during  fevers  and 
diabetes  is  habitually  ascribed  to  this  double  source,  disinte- 
gration of  nerve  and  muscular  tissues.  Now  our  tables  of 
urea  have  shown  that,  besides  marked  variations  according 
to  degrees  of  mental  activity,  a  regular  curve  of  .variation 
occurred  (in  the  majority  of  cases),  according  to  which  the 
amount  of  urea  excreted  was  increased  during  the  few  days 
preceding  menstruation,  generally  began  to  fall  during  the 
flow,  to  reach  a  minimum  point  just  afterwards.  In  some 
cases  it  was  increased  during  the  flow,  and  in  some  of  these 
cases,  at  least,  this  increase  seemed  to  be  due  to  increased 
mental  exertion.  But  when  this  circumstance  is  eliminated, 
the  quantitative  curve  of  urea  indicates  a  certain  increase  of 
disassimilation  in  nervo-muscular  tissues  during  the  premen- 
strual period,  and  a  diminution  of  the  same  during  the  men- 
strual and  post-menstrual  period.  The  diminution  may  pre- 
sumably be  attributed  either  to  diversion  of  the  circulation 
or  to  loss  of  blood  corpuscles.  The  premenstrual  increase 
can  only  be  explained  by  a  previous  increase  in  the  move- 
ment of  assimilation — such  as  should  result  from  increased 
blood  pressure  in  these  tissues. 


I  SO  THE   QUESTION   OF    REST   FOR   WOMEN. 

There  is,  therefore,  no  evidence  of  a  direct  rhythmic 
diminution  in  the  assimilation  of  plastic  material  in  muscu- 
lar tissue,  by  which  nutritive  material  might  be  periodically 
saved  for  reproduction.  There  is,  however,  evidence  of  a 
temporary  diminution  of  muscular  nutrition  during  the  men- 
strual flow  in  correlation  with  a  relative  temporary  increase 
which  occurs  just  before  it. 

In  regard  to  the  first  condition  modifying  muscular  nutri- 
tion, namely,  the  composition  of  the  blood,  the  absence  of 
the  positive  experiments  on  numeration  of  blood  corpuscles 
which  may  now  be  so  readily  performed,  compels  us  to  defer 
speculation.  If  we  should  argue  from  analogy  with  the  vas- 
cular tension  and  the  urea  curve,  we  should  expect  to  find  an 
increase  of  blood  corpuscles  during  the  premenstrual  period, 
which  should  compensate  their  loss  during  menstruation. 
But  if  we  judge  by  the  analogy  of  pregnancy,  we  should  ex- 
pect to  find  a  diminution  of  blood  corpuscles  relative  to  the 
plasma,  just  before  the  menstrual  parturition — a  diminution 
which,  in  pregnancy,  we  have  inferred  to  rather  imply  an  in- 
crease of  plasma.  It  is  noticeable  that  this  condition  of  the 
blood  in  the  latter  months  of  pregnancy  coincides  with  a  great 
rise  of  vascular  tension,  and  increase  in  the  excretion  of  urea. 
Leaving  this  most  interesting  detail  to  be  determined  by  fur- 
ther researches,1  we  may  consider  the  third  possible  modifica- 
tion of  chemical  processes  in  muscles,  that,  namely,  of  the  oxi- 
dations of  hydrocarbons,  upon  which  depends  the  accomplish- 
ment of  muscular  function.  We  have  seen  that  these  oxida- 
tions must  be  modified  by  the  abundance  and  rapidity  of  the 
circulation,  and  also  by  the  voluntary  innervation  which 
compels  muscular  contraction.  But  the  fact  that  these  same 
processes  are  slackened  or  quickened  according  to  the  de- 
mand for  the  production  of  heat — -demand  appreciated  by 
impressions  produced  upon  and  transmitted  by  the  super- 
ficial muscular  nerves — shows  that  modifications  of  these 
1  Which  we  have  already  begun. 


THEORY   OF   MUSCULAR   RESERVE.  l8l 

processes  may  be  initiated  within  the  muscle,  as  well  as  con- 
trolled from  without,  by,  for  instance,  variations  of  circulation. 

Let  us  suppose-  that  at  any  given  moment,  an  ideal  mo- 
ment of  complete  equilibrium,  the  amount  of  oxidizable 
material  in  the  juices  of  the  entire  muscular  system  consumed 
in  an  hour  =  A. 

Let  us  further  suppose  that  at  the  end  of  the  hour  a  spon- 
taneous slackening  of  the  oxidations  takes  place  under  the 
influence  of  reflex  nervous  impressions  analogous  to  those 
which,  in  some  as  yet  unknown  manner,  regulate  the  produc- 
tion of  heat,  at  the  end  of  the  second  hour,  the  total  amount 
of  material  consumed  would  =  A  +  A  —  a. 

If  the  ratio  of  diminution  continued  the  same,  we  should 
have  at  the  end  of  the  third  hour,  A  +  A  —  a  +  A  — -a,  and 
soon.  Let  A  —  12,  and  a  =  i.  Then  at  the  end  of  the  second 
hour  we  have  12+12  —  i  =  23.  At  the  end  of  the  third, 
12  +  12  —  i  +  12  —  i,  or  23  +11  =34,  and  at  the  end  of 
twelve  hours  would  equal  12  X  12  —  11  —  133.  Had  the 
equilibrium  been  maintained,  the  consumption  at  the  end  of 
twelve  hours  would  equal  144. 

Eleven  molecules  of  oxidizable  material  would,  therefore, 
remain  in  the  circulation,  because  while  the  supply  of  nutri- 
ment to  the  blood  remained  the  same,  elimination  from  the 
blood  had  been  diminished  to  that  amount.  The  change  in 
the  mass  of  the  blood  would  be  greater  than  is  indicated 
merely  by  these  figures.  The  afflux  of  blood  to  the  muscles 
is  diminished  by  diminution  in  the  activity  of  chemical  pro- 
cesses going  on  in  them,  out  of  proportion  to  the  diminution  of 
eliminated  material.  As  a  consequence,  the  whole  amount  of 
blood  remaining  the  same,  there  must  be  a  surplus  capable  of 
being  diverted  to  other  organs,  and  which,  until  so  diverted, 
continues  to  circulate  in  the  blood  vessels  and  increase  arterial 
tension.  Thus  would  be  fulfilled  the  conditions  which  are  in 
fact  observed  just  previous  to  menstruation,  and  in  this  wide 
spread  alteration  of  nutritive  processes  spontaneously  initi- 


1 82  THE    QUESTION   OF    REST    FOR   WOMEN. 

atcd  in  muscles,  relating,  not  to  their  assimilation,  but  their 
function,  we  should  discover  a  theoretically  satisfactory  origin 
for  the  surplus  nutritive  material  periodically  wasted  in 
menstruation. 

Finally,  while  the  diversion  of  blood  from  the  voluntary 
muscles,  diminishes  their  functional  capacity,  a  correlative 
afflux  of  blood  to  the  uterus,  should  increase  its  functional 
capacity,  /.  c.  the  contractility  of  its  muscular  fibre.  The 
small  increase  of  contractile  power  acquired  at  each  menstru- 
ation, is  needed  to  force  blood  towards  the  cavity  of  the 
uterus,  as  the  enormous  increase  at  parturition  is  needed  to 
expel  the  fruit  from  the  cavity. 

The  oxidations  of  muscular  juices  are  measured  by  the 
quantity  of  carbonic  acid  formed,  which  is  a  measure  both 
for  the  production  of  heat  and  the  intensity  of  muscular 
contraction. 

It  has  long  been  admitted  that,  during  menstrual  life, 
women  exhale  less  carbonic  acid  than  men,  measured  per  kil- 
ogramme of  weight  of  body.  It  is  also  known  that  in  case 
of  amenorrhea,  other  than  that  of  pregnancy  (?)  the  pro- 
portion of  carbonic  acid  in  the  expiration  of  the  one  sex 
becomes  equal  to  that  of  the  other.  No  measurements  have 
been  made  comparing  the  amount  of  carbonic  acid  exhaled 
by  women  at  different  periods  of  the  menstrual  cycle.  But 
the  general  correlation  between  menstruation  and  a  diminished 
quantity  of  carbonic  acid  was  insisted  upon  long  ago  by 
Andral  and  Gavarret,  whose  experiments  are  quoted  by  Aran 
in  defense  of  a  constitutional,  as  opposed  to  a  purely  local 
theory  of  menstruation.  The  experiment  required  to  test  the 
truth  of  our  hypothesis,  consists  in  a  daily  measurement  of 
the  amount  of  carbonic  acid  excreted  throughout  an  entire 
menstrual  cycle.  According  to  the  hypothesis,  this  amount 
should  be  at  a  maximum  at  the  middle  of  the  intermenstrual 
period,  should  then  gradually  diminish  to  a  minimum  just 
before  menstruation,  and  should  be  found  immediately  after 


NUTRITION   IN   MUSCLES  AND  NERVES.  183 

menstruation,  about  the  same  as  just  before,  and  this  should 
be  the  case  notwithstanding  a  different  curve  for  the  abund- 
ance of  red  corpuscles  in  the  blood. 

On  account  of  the  laborious  difficulties  of  this  experi- 
ment, we  have  as  yet  not  been  able  to  carry  it  out  with  the 
necessary  precision,  and  defer  appealing  to  it  until  researches 
in  regard  to  the  other  nutritive  curves  have  been  further 
developed.  We  are,  however,  justified  in  advancing  the 
theory,  as  a  strictly  "  verifiable  hypothesis,"  and  therefore 
admissible.  Partial  verifications  we  shall  endeavor  to  adduce 
further  on,  from  several  details  of  pathological  phenomena. 
It  is  worth  while  in  this  place,  however,  to  consider  whether 
the  arguments  we  have  offered  in  favor  of  an  alteration  of 
muscular  function  as  a  proximate  cause  of  menstruation,  i.  e., 
of  reproductive  capacity,  in  any  way  apply  to  the  function 
or  nutrition  of  nerve  centres.  There  is  much  looseness  of 
thought  in  the  present  day  about  these  latter  functions,  and 
confusion  between  them  and  those  of  the  muscles  ;  and  in  no 
connection,  perhaps,  is  this  confusion  more  palpable,  than 
when  the  reproductive  functions  of  women  are  under  con- 
sideration. 

Obscure  as  is  our  knowledge  of  the  chemical  processes 
of  nutrition  in  either  muscles  or  nerves,  a  few  facts  are  well 
established.  Assuming,  for  the  moment,  that  the  assimila- 
tive processes  securing  the  repair  of  waste  are  essentially  the 
same  in  the  nerve  cell  and  the  muscular  fibre,  we  have  every 
reason  to  believe  that  there  is  a  striking  contrast  between 
the  chemical  processes  underlying  their  respective  functions. 
It  is  certain  that  in  muscle  these  processes  consist  of  a  series 
of  oxidations,  or  of  reduction  of  complex  elements  to  simpler. 
But,  as  Wundt  points  out,  the  formation  in  the  nerve  centres 
of  the  complex  molecules  of  lecithine,  from  the  less  complex 
molecules  of  fat  and  albumen,  proves  that  in  at  least  these 
tissues  of  the  animal  body  are  carried  on  chemical  processes 
quite  other  than  those  of  oxidation.  Instead  of  a  reduction 


184  THE   QUESTION  OF     REST    FOR   WO.MEX. 

of  complex  molecules  to  simpler,  long  held  to  be  the  chemi- 
cal process  peculiar  to  animal  nutrition,  there  is  a  synthesis 
of  simpler  elements  to  more  complex,  such  as  takes  place  in 
plants.1  Now,  according  to  the  law  of  correlation  of  forces, 
force  becomes  latent  during  chemical  combination,  and  is  set 
free  during  chemical  decomposition.  During  the  formation 
of  lecithinc.  therefore,  in  the  interior  of  a  ganglion  cell 
force  becomes  latent,  or  is  stored  up  in  the  cell.  This  pro- 
cess constitutes  the  "negative  or  internal  work"  of  the  cell. 
When  the  molecule  of  lecithine  is  decomposed,  force  is  lib- 
erated, and  in  quantity  proportioned  to  the  extreme  atomic 
complexity  of  the  molecule.  This  force,  discharged  along 
the  motor  fibre  emanating  from  the  cell,  constitutes  the 
"  positive  or  external  work "  of  the  latter.  It  is  not  a 
strained  hypothesis  to  admit,  with  Wundt,  that  the  negative 
work  is  principally  effected  in  the  interior  of  the  cell,  and 
the  positive  at  the  periphery.  In  a  state  of  repose  or  equi- 
librium, a  rhythmic  alternation  is  constantly  maintained 
between  the  two  processes — rhythm  which  may  be  modified 
by  an}-  circumstance,  physiological  or  morbid,  which  facili- 
tates or  impedes  the  peripheric  discharge  of  force,  or  which 
increases  or  diminishes  its  central  accumulation  so  that  the 
proportions  between  the  two  processes  are  changed.  This 
mechanism  for  the  generation  or  accumulation  of  force  is 
probably  limited  to  the  ganglionic  nerve  cells,  and  in  inti- 
mate connection  with  their  recognized  influence  upon  gen- 
eral nutrition.  An  absolutely  larger  amount  of  material 
must  be  consumed  in  those  chemical  processes  which  result 
in  the  generation  of  nerve  force,  than  in  those  which  repair 
waste  in  tissue.  The  assimilation  of  albuminous  nutriment 
to  repair  waste  in  the  muscular  mass,  is,  on  the  contrary, 
from  its  greater  size,  on  a  larger  scale  in  these  tissues  than 
in  the  nervous.  The  double  processes  in  each  may  be  thus 
tabulated  : 

1  See  also  Hermann,  Habilitations  Schrift.  Zurich.  1869. 


FORMULA   FOR  NERVOUS  AND   MUSCULAR   NUTRITION.     185 
NERVOUS  TISSUES  (GANGLIONIC). 


Repair  of  waste.  DISCHARGE    OF     FORCE    (CEN- 

GENERAT.ON    OF    FORCE.  ™AL    °R    PERIPHEKIC    'N' 


MUSCULAR   TISSUES. 


REPAIR   OF   WASTE. 

DISCHARGE  OF  FORCE. 
CONVERSION   OF   FORCE. 


Or,  for  the  first  case,  we  might  construct  the  formula,  r  +  F 
=  D — for  the  second,  R  +  F  =  D.  Theoretically,  we  should 
presume  that  the  larger  letters  in  the  formula  were  those 
covering  the  widest  margin,  and  hence  admitting  of  greatest 
variation,  and  so  far  clinical  facts  abound  to  justify  this  pre- 
sumption. It  is  indeed  very  common  at  the  present  day  to 
ascribe  functional  nervous  disorders  to  "  deficient  nutrition," 
or  "  excessive  waste  "  of  nerve  substance.  As,  however,  in 
the  cases  in  question,  the  most  complete  development  of  the 
disease  (/'.  <?.,  spinal  irritation,  etc.)  remains  unattended  by- 
atrophy  of  nerve  substance,  not  the  least  anatomical  proof 
can  be  alleged  of  this  hypothetical  "  waste."  The  clinical 
facts  express  a  disturbance  in  the  special  function  of  the 
ganglion  cell,  i.  e.,  in  the  generation  or  in  the  discharge  of 
nerve  force.  It  is  theoretically  quite  conceivable,  although 
structural  waste  of  the  morphological  elements  of  the  cell 
were  completely  repaired,  that  alterations  should  occur  in 
the  formation  of  the  lecithine  molecule,1  or  in  the  process 
of  its  decomposition,  or  in  the  intra  cellular  molecular  circu-v 
lation,  or  in  the  degree  of  resistance  offered  by  inter  cellular 
fibres  to  the  transmission  of  impressions,  etc.  Indeed,  difcf/ 
turbance  in  the  functions  of  nerve  cells  must  imply  altera- 
tion of  one  or  more  of  these  processes.  To  go  behind  them, 

1  If  we  adopt  the  strongly  fortified  hypothesis  of  Wundt. 


1 86  THE   QUESTION   OF    REST    FOR   WOMEN. 

and  imagine  a  further  alteration  in  the  assimilation  or  dis- 
assimilation  processes,  i.  c.,  in  the  structural  nutrition  of  the 
cell,  as  a  necessary  basis  for  such  disturbance,  is  to  adopt  an 
hypothesis  for  which  there  is,  to  say  the  least,  no  proof,  nor 
by  anv  means  the  analogies  which  justify  Wundt's  scheme 
of  nerve  functions.  We  claim,  on  the  contrary,  from  the 
simplest  comparison  between  "  functional  "  diseases  of  the 
nervous  system,  and  the  organic  diseases  resulting  in  fatty 
degeneration,  atrophy,  and  sclerosis,  that  the  generation  of 
force  in  nerve  cells  is  very  frequently  interfered  with,  but  the 
repair  of  waste,  in  comparison,  rarely  ;  and,  almost  as  a 
corollary,  the  disturbance  of  function  results  in  disorders, 
which,  however  alarming,  may  be  cured ;  but  the  disturbance 
of  nutrition  results  in  lesions,  whose  effects,  infinitely  more 
insidious,  are  generally  incurable. 

These  considerations  should  already  show  that  there  can 
be  no  reason  for  presuming  identity  or  parallelism  between 
the  activity  of  the  nutrition  or  function  of  nerve  centres  and 
of  muscles.  The  current  theories  of  menstruation,  however, 
which  lay  great  stress  upon  the  generation  of  force  presumed 
to  be  involved  in  the  maturation  and  dehiscence  of  the  ovule, 
do  constantly  insist,  tacitly  or  implicitly,  that  in  order  to  com- 
pensate for  this  there  must  be  a  corresponding  diminution  in 
the  generation  of  force  elsewhere.  These  theories  assume  a 
spontaneous  diminution  in  the  functions  of  certain  nerve 
centres,  in  order  to  liberate  force  for  the  organs  of  reproduc- 
tion, in  a  manner  somewhat  analogous  to  the  diminution  in 
functional  muscular  nutrition  which  we  have  tried  to  show  is 
necessary,  in  order  to  provide  for  the  surplus  material  needed 
for  reproduction.  Besides  the  arguments  already  adduced  in 
favor  of  the  latter  theory,  we  may  urge  the  following  objec- 
tions against  the  former: 

i.  During  menstruation,  even  during  any  period  of  the 
menstrual  cycle  there  is  no  expenditure  of  plastic  nerve  force, 
especially  is  there  none  in  any  way  comparable  to  that  of  preg- 


NERVOUS   PHENOMENA   OF   MENSTRUATION.  iS/ 

nancy  with  which  nevertheless  it  is  often  half  consciously 
compared.  The  analogies  between  menstruation  and  preg- 
nancy relate  to  all  other  particulars  rather  than  this.  The 
ripening  of  the  ovarian  epithelium,  and  the  tumefaction  of 
the  uterine  mucous  membrane  are  nutritive  phenomena  on  a 
tolerably  minute  scale ;  involving  it  is  true  the  innervation 
of  the  organs,  as  do  nutritive  phenomena  in  any  organs,  but 
in  very  trifling  excess  at  one  time  of  the  menstrual  cycle  over 
another? 

2.  The  nervous  disturbances  that  so  frequently  accom- 
pany the  menstrual  hemorrhage,  (which  only  corresponds  to 
one  part  of  the  m  enstrual  cycle,  and   that  not  the  most  sig- 
nificant,) do  not  imply  an  "  increased  generation  of  force  "  in 
nerve  centres,  supposed  to  preside  over  the  organs  of  gener- 
ation.    They  constitute,  as  will  be  frequently  shown,  reflex 
irritations,  that  are  either  expended  on  the  muscular  fibre  of 
the  uterus,  causing  local  cramps,  or  on  any  distant  portions  of 
the  nervous  system  by  the  medium  of  the  spinal  cord  accord- 
ing  to  the    usual   mechanism    of  reflex    irritations.     They 
are  as  pathological  as  the  reflex  irritations  of  digestion  in 
dyspepsia. 

3.  In  the  absence  of  subjective  evidence,  the  vascular  tur- 
gescence  of  the  bulb  of  the  ovary  at  menstruation,  cannot 
be  assimilated  to  the  phenomena  of  erection,  nor  can  condi- 
tions of  innervation  analogous  to  those  of  the  latter  process 
be  inferred. 

Is  it  possible  to  arrive  at  any  numerical  equivalence  be- 
tween the  factors  of  which  we  believe  to  have  indicated  the 
equivalence,  or,  of  any  nearer  idea  of  the  mechanism  by  which 
the  equivalence  may  be  effected. 

To  do  this  we  should  not  rely  upon  comparison  of  the  aver- 
ages of  each  set  of  factors,  but  compare  in  a  series  of  individ- 
ual cases  the  following  groups  of  physiological  facts;  the 
muscular  strength  ;  the  evolution  of  heat,  and  its  consump- 
tion during  muscular  action  ;  the  number  of  blood  corpuscles  ; 


1 88  THE   QUESTION   OF   REST    FOR   WOMEN'. 

the  vital  capacity  of  the  lungs  ;  the  elimination  of  urea  ;  the 
excretion  of  C(X,  and  the  amount  of  menstrual  blood. 

These  should  be  measured  against  each  other  during  men- 
struation, and  during  the  premenstrual,  post-menstrual  and 
intermenstrual  periods.  As  it  is,  the  data  at  our  disposition 
are  extremely  imprecise.  In  regard  to  muscular  strength,  we 
have  the  rather  famous  measurements  of  Quetelet,  to  which 
reference  has  already  been  made.1  These  estimates  are  made 
by  means  of  a  dynamometer  that  measures  the  strength  of 
the  muscles  of  the  back  (force  rcnalc]  then  with  a  dynamom- 
eter for  the  hands. 

With  the  first,  Quetelet  found,  that  from  the  age  of  seven 
to  thirteen  the  strength  of  the  boy  to  that  of  the  girl  was  as 
14  to  10.  From  thirteen  to  eighteen  it  was  as  18  to  10.  Of 
the  man  after  twenty  to  the  woman  of  the  same  age,  as  14  to 
10,  or  nearly  double.  At  twenty,  the  force  of  the  two  hands  in 
the  man  was  78.6,  in  the  woman  46.6,  a  difference  of  32, 
which  is  proportionately  less. 

This  difference  of  muscular  strength  is  much  greater  than 
the  difference  of  muscular  mass.  It  implies  a  greater  intensity 
of  muscular  contraction.  But  this  implies  a  greater  con- 
sumption of  the  non-nitrogenous  substances  whose  oxida- 
tion supplies  the  heat-equivalent  of  the  mechanical  force 
evolved.2  It  is  this  same  class  of  substances,  especially  the 
fats  which  are  utilized  in  the  development  of  embryonic  tis- 
sues. In  non-pregnant  women,  there  is  more  fat  in  the  blood 
than  in  men  ;  in  pregnant  women  the  excess  of  fat  is  stored 
up  in  the  liver.  In  both  cases  it  is  saved  from  diminished 
muscular  consumption.  According  to  Longet,  women  have 
habitually  a  higher  temperature  than  men.  Is  less  heat  con- 
verted into  motor  force  ?  The  more  abundant  oxidation  in 
the  man,  necessitates  on  the  one  hand  a  larger  proportion 

1  Anthropometric,  p.  370,  1870. 

8  Hardy  ;  Principes  de  Chimie  Biologique,  p.  253,  1871.  See  also  Schiff,  Fisk, 
Gavarret,  Ranke,  etc.,  already  quoted. 


PROPORTION  OF  BLOOD  CORPUSCLES.        189 

of  blood  corpuscles  to  the  plasma  of  the  blood,  and  a  greater 
vital  capacity  of  the  lungs  in  respiration.  Since  the  introduc- 
tion of  methods  for  counting  directly  the  blood  corpuscles, 
no  other  method  of  estimating  them  can  be  relied  upon, 
except  for  the  most  approximate  estimate.  According  to  the 
older  method  employed  by  And.ral  and  Gavarret,  Becquerel 
and  Rodier,  Robin,1  and  Hoppe,"  the  proportion  of  blood 
corpuscles  to  a  thousand  parts  of  blood,  was  estimated. 
Robin  reckons  in  1,000  parts  of  blood,  320  red  corpuscles 
for  a  man,  and  300  for  a  woman,  that  is,  the  latter  should 
have  one-sixteenth  fewer  than  the  former.  By  the  new 
method,  the  number  of  corpuscles  in  a  cubic  millimetre  is 
enumerated.  Now  by  this  method,  it  has  been  shown  that 
a  healthy  man's  blood  contains  about  five  million  corpuscles 
to  the  cubic  millimetre,  a  woman's  four  million  and  a  half.3 

With  this  diminution  of  hematics  is  a  diminution  in  the 
amount  of  air  taken  into  the  lungs,  the  vital  capacity  of 
women  as  measured  by  the  spirometer  being  only  from  two- 
thirds  to  three-fourths  that  of  man's,  (Waldenburg,)  or 
16.7.5  cubic  centimetres,  for  every  one  centimetre  of  weight, 
instead  of  22-24  as  in  the  case  of  the  average  man, 
(Wintrich). 

Now  these  differences  do  not  correspond.  The  muscular 
force  is  half,  the  breathing  capacity  three-fourths,  the  num- 
ber of  hematics  destined  to  carry  oxygen  from  the  lungs  to 
the  muscles  is  nine-tenths  of  that  of  man. 

It  is  noteworthy  that  the  proportions  between  respiration 
and  muscular  force  are  much  nearer  approached  than  are 
either  to  the  proportion  of  blood  corpuscles. 

This  already  suggests  that  while  the  two  first  variations 
are  probably  in  relation  with  one  another,  the  latter  is  inde- 

1  Le9ons  sur  les  Humeurs.  p.  40,  1867. 
9  Physiol.  Chemie. 

8  This  is  the  calculation  of  Vierordt.  Keyes,  (loc.  cit.)  arrived  at  the  same  con- 
clusion. Malassez  gives  a  lower  estimate  for  the  blood  of  men,  4,500,000. 


190  THE   QUESTION   OF   REST    FOR  WOMEN. 

pendent  of  both.  The  estimate  of  the  number  of  blood  cor- 
puscles, indeed,  is  only  relative  to  the  amount  of  blood 
plasma,  and  is  to  be  accepted  quite  as  much  as  a  proof  that 
the  plasma  is  increased,  as  that  the  corpuscles  are  diminished. 
On  this  point,  a  remark  by  Robin  is  perhaps  apropos.  "  At 
the  moment  of  birth,  the  blood  cells  (hematics  and  leucocytes 
together),  instead  of  being  in  the  proportion  of  320  parts  to 
680  parts  of  plasma,  may  be  precisely  inverse,  that  is,  680 
parts  to  320  parts  of  plasma.  .  .  .  The  further  back  in 
the  intra-uterine  existence  the  examination  is  made,  the 
greater  is  the  proportion  of  the  globules.  .  .  .  The  reason 
is  easy  to  understand.  In  the  foetus  the  plasma  is  furnished 
entirely  by  the  mother,  is  apt  for  assimilation,  and  only  very 
little  elaborated  by  the  foetus,  consequently  it  is  assimilated 
as  fast  as  it  arrives,  so  that,  so  to  speak,  there  is  no  time  to 
increase  its  quantity,  proportionably  to  the  increase  in  the 
number  of  hematics. " — Loc.  cit.  p.  41.  If  now  in  the  woman, 
at  all  times  liable  to  the  demands  of  reproduction,  a  certain 
proportion  of  nutritive  plasma  remains  unassimilated  (see  ut 
supra),  it  will  remain  in  the  blood,  in  relative  excess  to  the 
number  of  blood  corpuscles,  and  tending,  unless  appropriated 
by  the  embryo,  to  accumulate  in  the  circulatory  system,  to 
raise  vascular  tension,  and  thus  to  prepare  the  way  for  the 
menstrual  hemorrhage.  The  same  reasoning  should  apply 
to  the  "physiological  anemia"  of  pregnancy.  From  this 
point  of  view,  therefore,  we  might  expect  to  find  a  relative 
diminution  of  blood  corpuscles  before  menstruation,  instead 
of  a  rise.  From  the  analogy  with  the  composition  of  the 
blood  in  pregnancy,  we  should  be  led  to  conclude  that, 
roughly  speaking,  the  number  of  hematics  furnished  the 
measure  for  the  energy  of  muscular  oxidation  and  evolution 
of  motor  force,  the  plasma,  for  the  abundance  of  nutritive 
material  and  reproductive  force. 

It  would  not  be  profitable  at  the  present  time,  and  with 
the  data  at   our  disposal,   to   pursue   this    inquiry   further; 


STATEMENT  OF  QUESTION.  IQI 

although  many  of  its  details  invite  investigation.  It  is  better 
for  the  purpose  of  this  Essay,  to  now  turn  our  attention  to 
applying  the  theory  of  menstruation  as  above  exposed 
towards  the  theoretical  elucidation  of  the  question :  Do 
women  require  rest  during  it  ? 


SECTION    VI. 

APPLICATION. 

FROM  the  review  of  the  menstrual  process  which  has 
been  given,  we  are  obliged  to  admit  several  decided 
contradictions  between  the  deductions  of  theory  and  the 
facts  of  practice.  Thus  we  have  seen  that,  in  the  great 
majority  of  cases,  when  menstrual  rest  is  either  advised  or 
taken,  it  is  made  to  coincide  exclusively  with  the  menstrual 
hemorrhage.  Yet  this  period,  as  Williams  justly  observes, 
is  really  the  least  important  of  all,  in  the  succession  of  periods 
constituting  the  entire  process. 

The  hyperaemia  of  the  uterine  mucous  membrane,  and 
frequently  also  (though  by  no  means  always)  of  the  ovarian 
bulb  and  Graafian  which  constitutes  the  so-called  "  pelvic 
congestion,"  precedes  menstruation,  i.  e.,  the  menstrual  flow, 
and,  if  analogous  to  pathological  congestions,  should  be  a 
period  of  sufficient  discomfort  and  local  distress  to  necessitate 
rest.  Yet  during  this  period,  the  majority  of  women  feel 
remarkably  well,  and  would  be  astonished  if  advised  to  keep 
their  bed  or  sofa.  Nor  are  they  recommended  to  do  so  by 
their  most  solicitous  advisers.  On  the  other  hand,  the  week 
succeeding  the  hemorrhage,  if  we  reason  from  analogy  with 
pathological  hemorrhages,1  should  be  a  period  of  exhaustion, 
during  which  again,  exertion  would  be  difficult  or  even  im- 

1  Other  than  haemoptysis,  after  which  the  patient  feels  often  extremely  re- 
freshed. The  reason  is  obvious  ;  the  hemorrhage,  as  in  menstruation,  has  been 
prepared  for  by  a  rise  of  vascular  tension,  that  upon  weak  nerve  centres  may 
cause  irritation  and  often  fever. 


PROPOSITIONS   ON    MENSTRUAL   PAIN.  Ip3 

possible.  Yet  in  the  majority  of  cases,  i.  e.,  of  women  con- 
sidered in  fair  health,  there  is  then  a  great  capacity  for  exer- 
tion, and  feeling  of  well  being  ;  "  Elle  est  plus  frais,  plus 
dispos,"  to  use  the  French  idiom.  On  the  other  hand,  the 
moment  when  the  pelvic  congestion  is  relieved,  the  height- 
ened muscular  tension  lowered  by  the  onset  of  the  hemor- 
rhage, is  the  time  when  pain  is  most  frequent,  and  when,  if 
ever,  the  woman  seeks  repose.  Two  questions  must  be 
answered,  1st,  Why  should  pain  ever  occur  at  this  time? 
2d,  What  relation  exists  between  the  successive  phases  of 
the  menstrual  process  as  we  understand  it,  and  the  variations 
in  the  clinical  phenomena  presented  by  women  at  the  periods 
corresponding  to  these  phases? 

The  following  propositions  require  no  argument  to  be 
admitted. 

1.  In  the  majority  of  women,  otherwise  in  good  health, 
who  suffer  pain,  this  begins  either  with  the  flow,  or  a  few 
hours  before,  and  lasts  six,  twelve,  twenty-four  hours  ;    in 
some  cases  forty-eight,  but  then  always,  in  the  cases  we  are 
considering,  in  much  diminished  severity. 

2.  In  a  limited  number  of  cases,  the  woman  feels  an  in- 
crease of  health,  and  especially  of  mental  vigor,  during  the 
period  of  the  menstrual  flow.     (We  have  several  such  on  our 
list.) 

3.  In  the  cases  of  pain,  it  consists  either  in  cramps,  or  in 
a  feeling  of  weight,  and  may  be  very  moderate  in  intensity. 

4.  Dysmenorrhea,  with  the  above  characters,  represents 
the  mildest  form,  and  often  scarcely  merits  the  name. 

5.  In  another  class  of  cases  the  pain  has  the  same  dura- 
tion, and  coincidence  with  the  flow,  but  is  much  increased 
in  severity,  the  cramps  being  violent  in  character,  and  bear- 
ing more  or  less  resemblance  to  pain  in  parturition.     This 
pain  generally  does  not  begin  until  after  the  flow. 

6.  In  both  the  above  classes,  the  premenstrual  period  is 
generally  one  of  increased  health  and  energy  ;  as  it  is  also  in 

J-3 


194  THE   QUESTION   OF    REST    FOR    WOMEN. 

the  cases  where  no  pain  is  suffered  at  all.  In  another  class, 
the  patients  begin  to  suffer  two  weeks,  one  week,  or  two 
days,  before  the  menstrual  flow,  from  backache,  pelvic  weight, 
or  even  burning  pain  in  the  hypogastrium.  Such  persons 
generally  suffer  burning  pain  at  menstruation  instead  of 
cramps.  The  cases  are  of  much  graver  import  than  the  pre- 
ceding. 

7.  The  post-menstrual  week  is  also  usually  a  period  of 
well  being.  This  condition  is  not  apt  to  be  damaged  by  the 
existence  of  pain  during  menstruation,  but  is  very  much 
affected  by  excessive  flowing,  which  nearly  always  leaves  a 
state  of  prostration,  which  often  is  not  recovered  from  for 
several  days. 

After  these  admitted  statements  a  few  postulates. 

1.  The  variations  in  the  quantity  of  the   menstrual  flux 
are  in  relation  partly  with  the  degree  of  individual  nutrition 
of  the  woman,  but  partly  also  with  the  rhythmic  wave  of 
supplemental  nutrition.     It  is  possible  that  the  latter  may  be 
defective,  yet  the  former  good,  indeed  better,  on  account  of 
the   deficiency   of  the   supplemental   wave.     Again,  the   old 
opinion  that  the  menstrual  flux  was  never  to  be  considered 
excessive,  unless  the  nutrition  or  nervo-muscular  energy  of 
the  woman  were  evidently  weakened  by  it,  is  true.     For  it 
may  imply  either  larger  absolute  development  of  the  supple- 
mental wave  of  nutrition,  or  a  less  demand  on  the  part  of  the 
nervo-muscular  tissues  from  the  individual  nutrition. 

2.  There  is  really  no  evidence  that  complete  amenorrhea, 
/.  c.,  without  menstrual   molimen,  is  ever  dependent  on  de- 
fective ovulation.1    After  extirpation  of  the  ovaries,  although 
menstrual  hemorrhage  usually  ceases,  the  menstrual  molimen 
frequently  persists.     Eight  cases  have  been  collected  where 
menstruation    returned    after  double    ovariotomy.     (Journal 
Obstet.) 

1  Although  Barnes,  Clinical  Lectures,  p.  iSl,  enumerates  this  as  a  cause,  and 
Althaus  (Med.  Times,  1874)  applies  electricity  to  the  ovaries  to  remedy  it. 


UTERINE   CONTRACTIONS   IN   MENSTRUATION.          193 

In  Dr.  Thomas'  case  of  normal  double  ovariotomy  for 
excessive  dysmenorrhea,  the  operation,  which  at  first  afforded 
relief,  was  afterwards  followed  by  a  return  of  periodical  pain. 
But  there  is  abundant  proof  of  its  dependence  upon  deficiency 
in  the  supplemental  nutrition,  and  its  frequent  association 
with  deficiency  of  individual  nutrition,  whose  original  start- 
ing point  is  more  frequently  an  alteration  in  \h&  functions  of 
the  nervous  system,  than  in  the  digestion  and  hematosis.1 

3.  Menorrhagia  and  dysmenorrhea,  on  the  contrary,  are 
much  more  frequently  to  be  traced  to  perversions  in  the 
assimilation  of  nutritive  material  by  the  blood  (simple  ane- 
mia), or  in  the  generation  of  force  in  nerve  centres  (neurotic 
anemia). 

The  cause  of  the  simple  spasmodic  form  of  menstrual 
pain  is  as  follows  : 

The  increased  rapidity  of  circulation  in  the  walls  of  the 
uterus  excites  the  contractility  of  the  uterine  fibres,  in  virtue 
of  which  the  blood  is  forced  towards  the  free  surface  of  the 
endometrium.  Rindfleisch 2  observes  that  the  hyperaemia  of 
mucous  membranes,  as  of  the  stomach  and  intestines,  is 
largely  effected  by  the  contractions  of  the  muscular  mem- 
branes underlying  them.  And  it  has  justly  been  observed 
that  the  parenchyma  of  the  uterus  is  to  be  considered  as  the 
muscular  wall  of  its  mucous  membrane,  hypertrophied  to 
meet  the  special  exigencies  of  the  organ. 

In  perfectly  normal  cases,  these  contractions  are  slow, 
rhythmic,  as  painless  as  the  contractions  of  the  uterus  de- 
monstrated to  occur  during  pregnancy,3  or  of  the  intestines 
in  healthy. peristaltis. 

If,  however,  the  vaso  motor  nerves  of  the  uterine  vessels 
become  irritated  under  the  increased  pressure  of  blood,  or  by 
transmitted  irritation  from  cerebro  spinal  centres,  unable  to 

1  Though  the  contrary  is  the  opinion  of  Beau,  as  expressed  in  his  treatise  on 
Dyspepsia. 

2  Pathologischen  Gewebelehre.  1871.    3  Snow  Beck.  Obstetrical  Trans.  1873. 


196  THE   QUESTION   OF   REST   FOR   WOMEN. 

sustain  the  increased  blood  pressure,  spasmodic  contractions 
of  blood  vessels  will  take  place  from  time  to  time,  rendering 
the  circulation  of  the  parenchyma  irregular,  the  fibre  here 
ancmiated  then  hypera^miated,  inducing  therefore  spasmodic, 
tetanic  contractions  of  the  muscular  fibre,  which  cause  pain 
of  various  degrees  of  intensity.1  Susceptibility  to  vaso  motor 
irritation  is  in  inverse  proportian  to  the  stability  of  function 
of  the  brain  and  spinal  cord,  therefore  this  form  of  dysme- 
norrhea  if  well  marked,  indicates  deficient  generation  offeree 
in  the  nerve  centres,  and  is  frequently,  (though  by  no  means 
always)  accompanied  by  cramps  of  the  stomach  and  intestine, 
dependent  on  the  same  conditions.  This  form  of  pain,  from 
its  cause,  ceases  when  the  increased  tension  in  the  blood 
vessels  of  the  parenchyma  is  relieved  by  the  rupture  of  blood 
vessels  in  the  tumefied  endometrium.  Hence,  in  the  mildest 
form  of  all,  it  subsides  in  from  two  to  six  hours.  When  pro- 
longed much  beyond  the  free  establishment  of  the  flow,  it 
shows  either  that  the  vaso  motor  irritation,  once  set  up,  per- 
sists after  cessation  of  its  cause,  as  is  common ;  or  else  that 
in  the  spasmodic  contraction  of  uterine  fibres,  the  os  is  fre- 
quently closed  to  the  egress  of  blood.  The  excess  of  vaso 
motor  irritation  is  a  proof  of  diminished  resistance  offered  by 
the  spinal  cord  to  the  transmission  of  impressions. 

This  form  of  dysmenorrhea  may  exist  from  the  begin- 
ning of  menstruation,  but  in  such  cases,  the  girls  are  either 
decidedly  neurotic,  (/.  c.  with  insufficient  assimilative  power 
in  the  tissues  of  the  nerve  centres,)  or  anemic,  i.  e.  with  insuf- 
ficient blood  to  nourish  them.  These  cases  are  very  frequent 
in  families  inheriting  consumption.  If,  however,  the  anemia 
be  pushed  beyond  a  certain  point,  the  supplemental  wave  of 
nutrition  never  rises  sufficiently  high,  to  greatly  increase  the 
tension  either  in  the  general  circulation  of  the  uterine  blood 

1  See  Oser  and  Schlesinger,  Schmidt's  Jahrbucher.  Experiments  on  Contrac 
lion?-,  of  uterus,  induced  by  closure  of  the  aorta.  Also  Putnam  Jacobi,  Note  on 
nitrite  of  amyle  in  dysmenorrhea,  Medical  Record,  1875. 


ANEMIC   DYSMENORRHEA.  197 

vessels.  Such  persons,  therefore,  though  feeble,  suffer  no 
pain  on  menstruation.  This  is  generally  scanty  ;  when  pro- 
fuse, (in  these  cases)  it  indicates  a  debilitated  relaxation  of 
blood  vessels,  unable  to  resist  the  periodical  tension.  We 
have,  as  in  all  vaso  motor  paresis,  reason  to  attribute  this  to 
paresis  of  central  innervaticm  ;  the  limit  is  passed  at  which 
irritation  of  vaso  motor  centres  is  occasioned,  and  it  is  re- 
placed by  vaso  motor  exhaustion  favoring  prolonged  hemor- 
rhage without  pain. 

These  considerations  answer  in  part  questions  I,  -2  and  3, 
on  p.  143. 

But  this  form  of  dysmenorrhea  is  often  acquired.1  Any 
conditi.on  capable  of  determining  the  requisite  degree  of 
anemia  or  of  neurosis  may  induce  it,  and  our  tables  of  cases 
show  a  number  of  instances  where  the  habit  of  spasmodic 
menstrual  pain  has  been  acquired  under  circumstances  tend- 
ing to  produce  these  conditions.  Over-work  is  one  frequent 
cause.  During  excessive  muscular  exercise  (i.  e.  as  compared 
to  the  individual  muscular  capacity)  the  blood  becomes 
watery,  (Ranke)  and  thus  anemia  produced.  But  on  our 
tables  we  have  very  few  cases,  (perhaps  half  a  dozen  from 
factory  girls,)  when  this  cause  could  be  alleged.  A  very 
much  larger  number  of  persons  have  been  engaged  in  work 
such  as  is  generally  described  as  involving  "  nervous  strain," 
such  as  teaching.  Now  "  nervous  strain  "  must  mean  exces- 
sive action  of  nerve  centres,  in  one  of  three  directions,  namely, 
intellectual  activity,  moral  emotion,  especially  anxiety,  or 
motor  force  expended  in  muscular  activity.  Teaching  six 
hours  a  day,  (we  select  this  occupation  as  the  one  most 
numerously  represented  on  our  tables,  and  also  on  the  census, 
after  agriculture  and  domestic  service,)  cannot  be  said  under 
ordinary  circumstances,  to  involve  any  excess  of  either  intel- 
lectual or  emotional  activity.  But,  when  analyzed,  we  find 

1  Whether  more  often  acquired  than  congenital,  *'.  e.  primary,  we  have  not,  at 
present,  data  to  determine. 


IQS  THE   QUESTION   OF   REST    FOR   WOMEX. 

that  it  docs  involve  much  forced  fixity  of  attention.  Now 
attention,  even  when  involuntary,  that  is,  excited  by  the  in- 
fluence of  an  absorbing  idea  or  emotion,  always  implies  the 
maintenance  of  muscles  in  a  fixed  position  for  a  certain 
length  of  time. 

Reading,  writing,  speaking  according  to  a  certain  routine, 
even  sitting  still  and  listening  to  a  recitation,  all  imply  that 
the  body  shall  be  held  steadily  in  a  certain  position,  which 
necessitates  the  voluntary  contraction  of  a  great  many  mus- 
cles. The  less  naturally  interesting  the  subject,  the  greater 
is  the  voluntary  effort  required  to  maintain  the  requisite 
muscular  tension,  hence  the  greater  the  liability  to  fatigue. 
But,  even  more  important  for  the  case  we  are  considering, 
the  mental  act  of  attention  requires  processes  in  nerve  centres, 
close!]'  analogous  to  those  wJiicli  precede  muscular  action,  if  in- 
died  the  motor  centres  themselves  be  not  ahvays  called  into 
activity  in  every  act  of  volition. 

The  first  elementary  expression  of  volition  is  a  muscular 
movement ;  the  first  degrees  of  complexity  in  the  develop- 
ment of  volition  are  expressed  by  corresponding  degrees  of 
combination  among  voluntary  muscular  movements;  and  the 
most  complete  determination  of  the  will  cannot  be  carried 
out  except  by  means  of  muscular  movements,  though  it  be 
only  those  required  for  speech  or  for  writing.1  In  this  ac- 
count the  ultimate  effect  of  work  involving  continuous  forced 
attention  and  little  apparent  muscular  activity,  may  be  ex- 
actly the  same  as  that  of  work  involving  much  muscular 
action  and  little  attention.  The  immediate  sensation  of 
fatigue  is  often  precisely  the  same,  indeed  is  often  much 
more  exhausting,  when  the  exertion  of  motor  force  has  been 
in  the  form  of  pure  volition  apparently  expended  on  the 
mind,  /.  c.  in  compelling  the  maintenance  of  a  certain  train  of 

1  This  proposition  in  regard  to  the  relation  of  all  acts  of  volition  to  the  motor 
centres,  must  be  left  in  this  place  undeveloped,  and  even  undefended,  from  lack  of 
space  and  time.  We  hope  to  enlarge  upon  it  on  another  occasion. 


FATIGUE   CAUSED   BY  ATTENTION.  199 

ideas,  as  when  it  has  been  expended  on  the  muscles.  It  has 
not  excited  that  increase  in  movements  of  nutrition,  by  which" 
muscular  activity,  unless  excessive,  is  habitually  compensated. 

Now  it  is  very  noticeable  in  women,  that,  as  their  charac- 
teristic bodily  deficiency  is  lack  of  muscular  strength,  so  their 
characteristic  mental  deficiency,  taken  as  a  class,  should  be 
lack  of  power  of  attention.  The  very  highest  degrees  of  sus- 
tained attention  have  rarely  been  even  attempted  by  women  : 
while  the  lower  degrees,  necessitated  by  the  exigencies  of 
every  day  life,  are  frequently  followed  by  a  collapse  of  nervous 
energy  that  seems  perfectly  unaccountable  when  we  consider 
only  the  amount  of  work  accomplished,  its  severity,  or  its 
difficulty.1  From  whatever  point  of  view  we  look,  we  find 
indeed  that  the  difficulty  of  the  work  bears  no  kind  of  pro- 
portion to  its  effect  upon  the  health  of  women."  But  they  are 
much  more  dependent  than  men  upon  their  degree  of  interest 
in  their  work,  for  the  reasons,  as  already  seen,  that  in  pro- 
portion as  the  work  is  interesting,  does  effort  become  invol- 
untary, and  require  less  deliberate  exercise  of  volition.  Very 
hard  work  that  thoroughly  excites  the  sympathies  may  be 
accomplished  with  ease.  This  is  of  course  true  both  of  men 
and  women.  But  it  is  very  much  more  true  of  the  latter, 
that  simple  continuous  work  which  is  either  indifferent  or 
repellent,  will,  if  pursued  for  a  long  time,  be  followed  by  a 
"  breaking  down  "  in  health. 

The  first  symptom  of  such  break  down  is  backache ;  the 
second,  a  greater  or  less  degree  of  pain  at  menstruation. 
Headache  and  neuralgia  occur  in  predisposed  persons. 

What  has  happened  in  such  cases  ?  We  think  that  the 
initial  circumstance  of  the  "  breaking  down,"  consists  in  an 
encroachment  upon  the  individual  nutrition  of  the  supple- 
mental wave  of  reproductive  nutrition,  which  we  have  held 
to  be  peculiar  to  the  female  economy. 

1  If,  however,  we  should  consider  absolutely,  the  amount  of  work  requiring 
sustained  attention  that  is  performed  by  women,  we  should  find  it  to  be  immense. 


2OO  THE    QUESTION    OF    REST    FOR  .WOMEN. 

The  backache,  so  often  mistaken  for  a  symptom  of  uterine 
disease,  is  the  typical  as  well  as  initial  symptom.  It  is  a 
marked  characteristic  of  the  chloro  anemia  of  puberty,  but  is 
rarely  absent  from  the  states  of  acquired  anemia  of  which  we 
are  speaking.  Let  us  see  if  the  theory  of  menstruation  as 
exposed,  will  offer  an  explanation  of  this  muscular  asthenopia. 

The  theory  of  muscular  contraction  shows  that  asthenapia. 
or  loss  of  function  may  be  quite  independent  of  alteration  of 
nutrition  proper,  /.  c.  of  assimilation  in  the  muscular  fibre. 
It  is  admitted  to-day  that  the  sensation  of  fatigue  depends 
on  the  accumulation  in  the  muscle  of  the  oxidized  products 
formed  during  the  process  of  muscular  contraction.  Since 
both  the  oxidations  and  the  circulation  of  the  blood  current 
which  washes  away  their  products,  are  involuntary  move- 
ments regulated  by  the  reflex  innervations  of  the  muscle,  the 
sensation  of  fatigue  may  be  prematurely  determined  by  alter- 
ations in  this  innervation,  especially  at  the  central,  i.  c.  spinal 
cord  portion  of  the  reflex  arc.  Exhaustion  of  the  innerva- 
tion in  this  way  causes  muscular  weakness  and  fatigue.  On 
the  other  hand,  the  innervation  remaining  intact,  the  mole- 
cular movements  of  the  muscular  fibre  during  contraction,- 
may  be  so  diminished  in  energy  that  all  the'  heat  evolved  in 
the  oxidation  is  not  converted  into  motion,  hence  the  demand 
for  oxidation  ceases  before  the  chemical  process  initiated  by 
the  influx  of  nerve  force,  has  been  completed.  Instead  there- 
fore of  continuing  to  the  ultimate  term,  the  formation  of 
carbonic  acid,  the  process  stops  short  while  yet  incomplete, 
and  partially  oxidized  material  remains,  producing  the  sen- 
sation of  fatigue.  Asthenopia  would  then  be  really  of  muscular 
origin,  starting  from  the  perverted  mode  of  function  of  mus- 
cular fibre.  Many  facts  of  physiological  experiment,  showing 
the. degree  of  independence  of  muscle  and  nerve,  indicate  the 
possibility  of  such  an  independent  starting  point,  however 
obscurely  we  can  represent  to  ourselves  the  precise  condition 
in  which  it  consists. 


ENCROACHMENT   ON   MUSCULAR   NUTRITION.          2OI 

Assuming,  however,  as  we  are  so  well  justified  in  doing, 
a  change  in  the  molecular  movements  of  the  sarcous  ele- 
ments, whereby  the  energy  of  muscular  contraction  as  a 
whole  is  diminished,  we  must  seek  the  cause  of  this  change 
in  the  structure  or  chemical  composition  of  these  elements. 
This  must  be  effected  by  the  assimilation  and  disassimilation 
carried  on  in  them  ;  in  other  words,  by  their  nutrition  proper. 
To  say  that  a  badly  nourished  muscle  contracts  feebly,  is 
only  to  state  a  well  known  clinical  fact. 

Let  us  suppose  that  the  habitual  force  of  muscular  con- 
traction was  diminished  by  one-quarter  from  a  type  standard. 
There  would  be  a  corresponding  diminution  in  the  afflux  of 
blood  to  the  muscles — thus  also  one-quarter.  Suppose,  fur- 
ther, that  the  habitual  margin  left  for  periodical  reproductive 
diminution  in  the  energy  of  muscular  function  was  one-eighth 
of  the  whole  amount ;  it  would  therefore,  in  the  given  case,  be 
one-eighth  of  three-quarters  (-^  of  f  =  •/-%),  or  about  one-tenth 
instead  of  one-eighth.  But  this  amount  may  be  insufficient  to 
liberate  the  amount  of  blood  required  for  the  reproductive 
node,1  that  is,  for  menstruation.  As  the  necessity  for  repro- 
ductive nutrition,  once  established,  will,  for  a  long  time,  take 
the  precedence  of  individual  nutrition,2  the  deficiency  must 
be  made  up,  and  is  made  up  by  diminishing  the  afflux  of 
blood  and  nutritive  material  required,  not  only  for  the  func- 
tions of  the  muscle,  but  for  the  repair  of  waste  in  its  fibre. 
Hence  insufficient  nutrition  of  muscular  fibre,  and  then,  by 
the  vicious  circle  common  to  all  pathological  processes, 
diminished  contractility  or  function,  pain  in  function,  especi- 
ally of  the  muscular  fibres  of  the  uterus,  diminished  afflux 
of  blood  for  further  nutrition. 

A  suggestion  in  passing.  It  is  known  that  in  vegetables 
reproduction  ceases  unless  the  individual  nutrition  be  devel- 

1  The  term  "  node  "  is  of  course  used  here  from  the  analogy  with  plants. 
*  Which,  for  the  human  species,  is  equivalent  to  saying  that  profoundly  ane- 
mic women  will  continue  to  menstruate  and  bear  children. 


202  THE    QUESTION    OF    REST    EOR   WOMEN. 

oped  to  a  certain  standard,  while  in  animals  reproduction 
continues  long  after  profound  deterioration  of  the  individual 
nutrition.  Is  not  this  because  in  the  former,  material  for 
reproduction  can  only  be  saved  out  of  the  material  for  indi- 
vidual nutrition,  while  in  the  latter,  the  reserve  is  formed  by 
the  material  that  would  be  used  in  functions  ? 

From  the  above,  we  should  conclude  that  the  circum- 
stance which  mainly  favors  the  deterioration  of  muscular 
nutrition  by  the  supplemental  reproductive  wave,  is  the 
original  feebleness  of  muscular  function.  Practically  we  find 
that  the  habit  of  disordered  and  painful  menstruation  is  more 
frequently  associated  with  habits  of  feeble  muscular  exercise 
than  with  any  other  one  circumstance. 

Into  the  effects  of  overwork  upon  the  nervous  apparatus 
of  women,  in  connection  with  menstruation,  it  is  much  more 
difficult  to  enter,  because  the  normal  relations  bet-ween  the 
two  are  much  more  obscure.  The  facts  so  often  alleged  in 
profusion  to  demonstrate  a  peculiarly  intimate  relation,  can, 
as  we  have  seen,  all  be  classified  as  cases  of  reflex  irritation, 
in  which  impressions  have  been  transmitted  to  nerve  centres 
whose  power  of  resistance  has  been  abnormally  diminished. 
"  The  neuroses  of  menstruation,"  on  which  Berthier  has 
written  a  voluminous  monograph,  all  belong  to  this  class. 
Hysteria,  convulsions,  paroxysms  of  insanity,  simple  out- 
bursts of  ill-temper,  headaches,  cramps,  catalepsies,  phenom- 
ena however  extraordinary  or  however  multiplied,  add 
nothing  to  the  principle  already  contained  in  the  simplest. 
This  principle  is,  that  any  new  vital  action,  /'.  r.,  a  process  in 
any  organ  or  tissue  necessarily  involving  vascularization  and 
innervation,  may  become  the  starting  point  of  impressions 
that,  when  transmitted  by  centripetal  nerves,  will  be  extin- 
guished in  nerve  centres  of  normal  power  of  resistance,  but 
will  be  diffused  in  centres  of  diminished  power  of  resistance. 
Or  again,  with  normal  resistance  in  nerve  centres,  a  per- 
verted vital  action  on  the  periphery,  irritating  nerve  filaments, 


REFLEX   DISORDERS   OF   MENSTRUATION.  2O3 

may  again  cause  centric  irritation.  The  case  of  menstrua- 
tion is  precisely  paralleled  by  that  of  teething.  In  men- 
struation, the  second  condition  is  fulfilled  either  in  the 
obscure  disease  known  as  "  subacute  ovaritis,"  where  the  vas- 
cular turgescence  accompanying  the  rupture  of  the  follicle 
becomes  a  source  of  irritation  to  the  ovarian  nerves,  or  else, 
in  the  various  conditions  of  irregular  circulation,  or  imperfect 
nutrition  or  contractility  of  the  muscular  fibre  of  the  uterus, 
which  renders  the  afflux  of  blood  towards  the  cavity  a  source 
of  irritation  to  the  nerves  of  the  parenchyma. 

The  essential  precaution  against  such  reflex  disorders 
consists  in  obtaining  such  an  organization  of  the  central 
nervous  system  as  will  raise  its  power  of  resistance  to  peri- 
pheric  impressions  to  the  normal  standard.  This  is  chiefly 
done  either  through  inheritance,  or  through  influences  brought 
to  bear  during  childhood.  Much  less  can  be  effected  in  adult 
life,  especially  in  relation  to  regularly  recurring  impressions 
at  long  intervals,  like  those  from  the  uterus  and  ovaries  at 
menstruation. 

It  appears  evident,  therefore,  that  the  functional  condi- 
tion of  the  muscular  system  at  puberty,  and  the  organic  con- 
dition of  the  nerve  centres,  powerfully  influence  the  regular- 
ity and  tranquillity  of  the  menstrual  process.  Disturbance 
is  acquired  when  these  conditions  have  been  determined  by 
the  given  influence  ;  for  instance,  by  overwork.  Thus: 

1.  In  work  involving  much  muscular  exertion,  or  exer- 
tion long  time  repeated,  the  supplemental  wave  of  nutrition 
may  be  unable  to  establish  itself  out  of  the  small  residue  of 
nutriment  left  over  from  that  consumed  in  the  function  of 
the  muscles  ;  it  then  will  be  derived  from  their  nutrition,  and 
then  the  chain  of  sequences  already  noted  l  will  be  initiated. 

2.  In  work  involving  much  fixed  attention,  and  perhaps 
the  activity  of  motor  centres  in  the  brain,  the  generation  of 
force  in  the  nerve  centres  seems  liable  to  become  impaired, 

1  See  p.  201. 


204  THE   QUESTION   OF    REST    FOR   WOMEN. 

and,  coincident!}-,  their  resistance  to  impressions  diminished. 
In  this  case,  amidst  much  which  is  obscure,  \ve  can  distinguish 
the  general  fact  that  the  repeated  expenditure  of  nerve  force 
finally  renders  the  generation  of  force  difficult.  All  excita- 
tion is  so  rapidly  transferred  to  the  periphery  of  ganglionic 
cells,  that  too  little  remains  to  store  up  force  in  the  centre. 

That  the  ganglionic  nerve  cells  of  women  seem,  on 
the  whole,  to  be  more  easily  exhausted  than  those  of  men, 
so  that  prolonged  effort  requiring  prolonged  generation  of 
nerve  force  is  more  readily  followed  by  collapse^  is  a  fact 
that  cannot  be  doubted.  That  this  peculiarity  must  be  in 
some  way  dependent  upon  their  reproductive  nutrition  is 
also  certain,  but  the  exact  relation  between  is  not  easy  to 
determine,  even  hypothetically.  There  is,  however,  much 
reason  to  believe  that  the  relation  exists  through  the  medium 
of  the  muscular  system.  As  the  vito-chemical  processes 
carried  on  at  the  periphery  of  the  nervous  system  in  mus- 
cular and  other  tissues  are  constantly  regulated  by  the  influx 
of  forces  coming  from  the  nerve  centres,  so  the  generation 
of  force  in  these  centres  is  constantly  influenced  by  the 
arrival  of  impressions  coming  from  the  periphery,  and  by 
none  more  than  those  caused  by  muscular  contractions.  The 
influence  of  systematic  muscular  exercise,  passive  or  active, 
upon  the  nerve  centres,  is  most  strikingly  manifested  in  many 
well  known  cases  of  nervous  disease,  as,  to  a  certain  extent, 
hemicrania,  and  still  more  notably,  spinal  exhaustion.  The 
feebler  muscular  contraction  in  woman,  therefore,  should  be 
expected  to  correspond  to  a  diminished  quantum  of  force 
generated  in  the  centres  connected  with  centripetal  muscular 
nerve  fibres. 

For  reasons  already  urged,  the  peculiarities  observed  in 
women's  power  of  exertion  and  attention  are  theoretically 
explained  by  such  peculiarities  limited  to  the  motor  centres. 
They  do  not  imply,  and  there  is  much  difficulty  in  admitting,  a 
primary  extension  of  the  rule  to  sensory  or  intellectual  centres. 


MUSCULAR   HYSTERIA.  2O5 

An  apparent  exception  exists  in  the  case  of  peasant 
women  with  strongly  developed  muscular  systems,  who  are 
yet  not  unfrequently  liable  to  hysteria  in  its  most  violent 
convulsive  form — liability  which  proves  greatly  diminished 
resistance  to  the  diffusion  of  impressions  in  the  nerve  centres. 
We  have  ourselves  noticed  such  muscular  hysteria,  whose 
paroxysms  generally  coincided  with  the  menstrual  period,  in 
a  girl  whose  mental  development  was  arrested  on  the  borders 
of  idiocy ;  and  such  cases  are  common.  These  must  cer- 
tainly all  be  referred  to  an  original  imperfection  of  structure 
of  the  nerve  centres,  involving  the  sensory  and  intellectual 
centres  to  a  much  greater  extent  than  the  motor.  This  is 
positively  proved  by  the  large  amount  of  power  possessed 
to  sustain  prolonged  and  intense  motor  exertion,  and  the 
deficiency  in  the  power  to  resist  sensory  impressions,  or  to 
generate  or  combine  ideas.  The  condition  of  such  women  is 
precisely  the  inverse  of  that  typically  characteristic  of  their 
sex. 

To  say  that  the  quantum  of  force  habitually  generated 
in  a  given  time  in  one  nerve  cell,  is  less  than  that  in  another, 
is  to  say  that  the  periods  of  expenditure  of  force  must  be 
shorter  for  the  second  than  for  the  first,  and  the  interval 
of  repose  longer,  in  order  that  an  identical  amount  of  force 
may  be  obtained  from  both.  The  case  is  analogous  to  that 
of  a  feebly  contracting  heart,  when  by  the  administration  of 
digitalis,  which  prolongs  the  intervals  between  the  contrac- 
tions, a  greater  amount  of  force  is  accumulated  to  be  ex- 
pended at  each  of  them. 

The  practical  inference  to  be  drawn  from  these  considera- 
tions, in  regard  to  the  adjustment  of  female  work  to  the 
reproductive  necessities  of  her  economy,  is,  that  this  should 
be  constantly  intermittent,  not  at  long  intervals  but  at  short, 
Since  the  menstrual  flow  does  not  itself  constitute  the  repro- 
ductive demand  made  upon  the  individual  nutrition,  but 
only  expresses  the  result  of  that  demand,  since  the  latter  is 


206  THE    QUESTION   OF   REST    FOR   WOMEN. 

made  constantly,  and  only  its  effects  accumulate  in  a  rising 
curve,  nothing  would  be  gained,  but  much  lost,  by  a  single 
intermittence  of  work  during  the  few  days  of  the  menstrual 
hemorrhage,  the  strenuousness  of  the  rest  of  the  month 
being  left  unchanged.  From  all  the  facts  hitherto  reviewed, 
we  can  find  none  to  indicate  that  such  a  method  of  rest 
would  prevent  the  occurrence  of  pain  or  breaking  down  in 
health,  in  any  peculiar  way,  or  different  from  what  might  be 
expected  of  frequent  vacations  taken  at  any  other  time. 
Nor  from  our  tables  of  cases,  do  we  find  that  the  habit  of 
resting  exclusively  at  this  time,  frequently  acquired  when 
menstruation  habitually  became  painful,  ever  exercised  any 
influence  in  removing  the  pain.  This  might  be  removed  by 
other  agencies ;  it  would  always  be  rendered  more  tolerable 
by  repose,  but  there  is  nothing,  at  least  in  the  evidence 
before  us,  to  show  that  exclusively  menstrual  rest  is  capable 
of  exerting  a  curative  influence.  The  kind  of  rest  needed  by 
women  consists  in  interruptions  to  employment  every  two 
or  three  hours,  not  every  three  or  four  weeks.1  The  immense 
preponderance  of  domestic  service  over  every  other  form  of 
female  labor,  we  mean  of  labor  demanding  the  same  degree 
of  capacity,  is  in  itself  an  indication  of  preference  for  work 
involving  more  hours  but  frequent  interruptions,  over  work 
more  compactly  arranged,  in  an  unbroken  series  of  hours, 
though  these  terminated  earlier.  On  the  other  hand,  in 
higher  employments,  eight  hours  steady  work  is  felt  as  a' 
severe  burden,  when  we  believe  (we  are  not  at  this  moment 
prepared  to  absolutely  prove  it)  two  sessions  of  work,  of  four 
hours  each,  would  entail  little  fatigue. 

We  do  not,  therefore,  find  it  necessary  to  assert,  even 
theoretically,  that  since  muscular  power  is  diminished  in 

1  Thackrah,  in  his  pioneer  treatise  on  the  influence  of  the  professions  upon 
health,  mentions  the  marked  improvement  effected  in  the  condition  of  the  opera- 
tives in  a  certain  factory  after  the  habit  of  an  afternoon  lunch  had  been  intro- 
duced (1837). 


WOMEN'S  CAPACITY   FOR   MUSCULAR   WORK.  2O/ 

women,  in  correlation  with  their  immense  capacity  for  repro- 
duction, that  therefore  they  should  never  be  allowed  to  per- 
form any  muscular  work  at  all.  On  the  contrary,  as  in  the 
most  abstract  sense  movement  has  been  shown  to  be  the  one 
principle  out  of  which  all  forms  of  existence  were  differen- 
tiated ;  as  motor  force  has  been  shown  to  be,  in  animals,  the 
reserve  or  balance  fund,  by  which  differences,  and  especially 
differences  between  the  two  sexes,  are  brought  into  equilib- 
rium ;  so  in  the  female  sex,  does  the  muscular  nutrition  con- 
stitute the  main  reserve,  out  of  which  may  be  met  all  the 
demands  of  reproduction,  without  detriment  to  the  individual 
life.  It  is  well  known  that  muscular  exercise  increases  mus- 
cular nutrition.  It  increases  the  sum  of  nutritive  material 
stored  up  in  the  muscles,  ready  at  any  moment  to  be  appro- 
priated, either  for  the  evolution  of  motor  force  in  muscular 
contractions,  or  for  the  development  of  the  supplemental 
wave  of  nutrition,  destined  to  terminate  after  one  month  in 
menstruation,  or  after  nine  months,  in  parturition.  The 
more  the  muscles  are  exercised,  the  larger  their  mass,  hence 
the  larger  the  amount  of  nutritive  material  stored  up  in  them 
for  this  double  disposition ;  hence  the  less  the  danger  that 
the  development  of  the  supplemental  wave  shall  encroach 
upon  the  nutriment  necessary  for  the  muscles  or  the  nerve 
centres.  The  consequences  of  excessive  muscular  action,  i.  e. 
what  is  beyond  the  assimilative  capacity  of  the  muscular 
fibres  to  repair,  have  been  several  times  referred  to  in  the 
preceding  pages.  Such  consequences  are  undoubtedly  in- 
curred among  the  working  classes  of  Europe,  though  less 
among  the  agriculturists  than  might  be  expected.  In  them, 
muscular  nutrition  seerns  to  invariably  increase  in  exact  pro- 
portion to  the  demand  for  muscular  strength ;  and  whoever 
has  ever  watched  the  female  porters  at  Boulogne  handle 
trunks  that  gentlemen  travellers  would  hesitate  to  lift,  may 
doubt  whether  there  be  any  limit  to  the  development  of 


208  THE    QUESTION    OF    REST    FOR   WOMEN. 

muscular  power  in  female  peasants.1  The  brutishness  of  the 
nervous  system  in  these  persons  suggests  that  in  them  the 
entire  activity  of  the  nervous  system  had  been  concentrated 
on  the  motor  centres — result  certainly  most  undesirable. 
But  in  this  country,  the  danger  is  certainly  the  other  way. 
A  cardinal  weakness  is  left  in  the  basis  of  our  society  by  the 
absence  of  peasantry  and  of  peasant  blood — weakness  only 
to  be  compensated  by  a  strenuous  cultivation,  to  which  our 
country  people  have  not  attained.  Little  work  is  here 
attempted  that  is  beyond  what  should  be  the  standard  of  a 
healthy  woman's  strength,  while  very  much  is  declined  that 
is  unquestionably  within  its  compass.  The  defects  in  the 
industrial  or  other  work  occupying  our  women,  lie,  not  in 
the  degree  of  force  required  for  its  accomplishment,  but  in 
the  prolonged  sessions  during  which  the  force  must  be  ex- 
erted, or  in  the  constrained  positions  it  necessitates.  What- 
ever posture  interferes  with  the  free  return  of  venous  blood, 
especially  from  the  pelvis,  is  injurious  to  a  woman.  Hence, 
of  course,  long  continued  standing. 

But,  without  permitting  ourselves  to  speculate  on  the 
probabilities  of  over-work  among  the  mass  of  women,  and 
confining  ourselves  to  our  personal  statistics,  we  find  that  on 
the  one  hand  a  certain  number  (32,  or  44.^  per  cent.)  acquired 
menstrual  pain  without  losing  good  general  health,  which  is 
contrary  to  the  series  of  pathological  processes  above  detailed  ; 
and  on  the  other  hand,  that  among  those  in  whom  menstru- 
ation became  painful,  the  number  engaged  in  fixed  employ- 
ment was  decidedly  less  than  the  number  having  no  employ- 
ment at  all  (31  per  cent,  against  52  per  cent,  unmarried,  p. 
61).  Of  course  in  the  latter  cases,  the  question  of  methods 
of  work  or  over-work  do  not  come  up.  What  circumstances 
should  make  so  large  a  proportion  of  persons  suffer  during  a 

1  "  Mighty  daughters  of  the  plough, 
Stronger  than  men." 


MENSTRUAL   PAIN   INDEPENDENT   OF   OVERWORK.     2CXJ 

menstruation,  who  had  not  been  predisposed  to  such  suffer- 
ing by  congenital  or  hereditary  conditions  ? 

Since  menstrual  pain,  at  least  of  the  character,  duration 
and  intensity  that  we  are  now  considering,  is  so  frequent  a 
symptom  of  deterioration  of  general  health  from  any  cause, 
and  since  in  the  wear  and  tear  of  existence,  women  as  well  as 
men  are  exposed  to  the  trials,  moral  and  physical,  whose 
repetition  is  destined  to  ultimately  exhaust  the  sum  of  vital 
resistance,  it  is  to  be  expected  that  its  occurrence  would  often 
have  no  more  special  significance  than  the  occurrence  of  dys- 
pepsia or  headache  in  either  sex.  But  in  addition  there  is 
one  special  condition  represented  in  our  tables,  namely,  celi- 
bacy. By  reference  to  the  tables,  it  will  be  seen  that  the 
proportion  of  married  women  who  learned  to  suffer  at  men- 
struation was  1 1  per  cent.,  while  that  of  unmarried  was  84 
per  cent.  (p.  125.)  The  influence  of  celibacy  is  of  the  utmost 
importance  in  estimating  the  health  of  adult  women,  es- 
pecially in  the  upper  classes,  but  this  influence,  which  has 
been  frequently  signalized  by  gynecologists,  is  very  much 
neglected  by  hygienists  and  sociologists.  The  influence  works 
in  three  directions, 

I.  In  all  the  social  classes  in  which  marriage  is  considered 
the  only  possible  or  at  least  the  only  desirable  career  for 
women,  no  other  resources  are  accumulated,  and  celibacy 
implies  a  social  failure,  for  which  exists  hardly  a  pretext  of 
compensation.  This  is  all  the  more  depressing  to  women  on 
account  of  their  habitual  dependence  upon  social  opinion, 
and  slender  habits  of  personal  resource.  To  this  general 
cause  of  depression  must  often  be  added  the  personal  disap- 
pointments which  may  have  been  the  proximate  cause  of 
celibacy.  Depressing  moral  emotions  always  tend  to  inter- 
fere with  the  nutrition  of  the  nerve  centres  that  constitute 
the  organs  of  thought,1  and  thenoe  secondarily  of  other  centres, 
and  of  the  blood. 

1  We  could  allege  many  instances  of  this.    See  Tuke,  Influence  of  Mind  on  Body. 
14 


2IO  THE   QUESTION   OF    REST    FOR   WOMEN. 

2.  The  rhythmic  waves  of  nutrition  which,  in  the  non-preg- 
nant woman,  rise  and  fall  in  monthly  periods,  are  destined 
by  tne  necessities  of  reproduction,  to  be  interrupted  from 
time  to  time,  and  be  replaced  by  the  longer  system  and  more 
powerful  nutritive  wave  of  pregnancy. 

In  a  normal  pregnancy,  this  follows  precisely  the  type  of 
the  mensual  waves,  that  is,  it  starts  from  a  minimum  point, 
both  in  the  nutrition  of  the  embryo  and  of  the  mother,  imme- 
diately after  conception,  and  rises  to  a  maximum  just  before 
parturition.  We  have  seen  that  at  this  time  the  assimilable 
blood  plasma  is  the  most  abundant  relative  to  the  corpuscles,1 
the  vascular  tension,  the  highest,  the  excretion  of  urea  most 
abundant,  muscular  force  alone  is  diminished,2  as  if  by  ex- 
perimental magnifying  of  the  minute  diminutions  effected 
for  menstruation.  In  pregnancy  therefore  holds  true,  and  on 
a  larger  and  more  important  scale,  the  remark  we  have  made 
in  regard  to  the  nutritive  wave  preparatory  to  menstruation, 
namely,  that  its  effects  transcend  the  limits  of  the  supple- 
mental nutrition,  and  are  experienced  by  the  individual  tis- 
sues of  the  mother.  The  reverse  may  be  true  of  course,  and 
after  a  certain  number  of  pregnancies,  the  reproductive  wave 
is  liable  to  be  maintained  only  at  the  expense  of  the  maternal 

1  Whence  their  relative  diminution. 

•  This  is  not  the  place  to  show  as  we  think  might  be  done,  that  a  large  amount 
at  least  of  aj- parent  intellectual  inferiority  in  women  is  due  to  deficiency  of  mus- 
cular tonicity.  Without  this,  there  is  none  of  the  feeling  of  elasticity  and  enter- 
prise that  is  as  requisite,  nay  more  so,  to  pursue  a  chain  of  thought,  as  to  accom- 
plish many  physical  actions.  Ml  intellectual  actions  require  muscular  actions  for 
their  expression.  The  maximum  is  in  scientific  investigations.  We  think  it  not  too 
bold  a  generalization  to  assert,  that  the  antagonism  held  by  many  to  exist  between 
the  intellectual  capacity  and  reproductive  force  in  women,  and  which  in  a  certain 
sense  and  to  a  certain  extent  exists,  does  so  through  the  medium  of  the  muscular 
system  and  muscular  energy.  Development  of  the  latter  alone,  merely  leads  to 
more  fertile  reproduction,  a~,  in  peasant  women.  But  the  systematic  development 
of  muscular  force,  in  connection  with  systematic  training  of  the  nerve  centres  of 
intelligence  and  will,  should  greatly  increase  if  not  the  amount  of  intellectual 
force  generated,  at  least  very  largely  the  amount  of  it  that  is  made  effective. 


MENSTRUATION   AND   PREGNANCY.  211 

nutrition.1  But  these  cases  are  pathological.  It  is  note- 
worthy that  they  are  much  more  frequent  after  the  multiple 
pregnancies  of  healthy  women,  than  at  the  first  pregnancy  of 
a  delicate  one ;  chloro  anemic  girls  frequently  become  fat, 
strong  and  rosy,  during  their  first  pregnancy,  to  fall  into 
anemia  again  it  is  true,  during  lactation,  but  not  unfrequently 
to  have  their  health  permanently  improved.  The  reproduc- 
tive force  for  women,  as  for  plants,  is  fixed  not  only  accord- 
ing to  the  race,  but  according  to  the  individual.  The  power 
of  voluntarily  increasing  the  achievements  of  this  force,  by 
multiplying  at  will  the  number  of  pregnancies,  is  only  appar- 
ent ;  for,  as  we  have  seen,  if  the  resources  of  reproductive 
nutrition  or  force  are  exhausted,  they  are  not  regained,  but 
eked  out  at  the  expense  of  the  maternal  organism.  Con- 
versely, the  power  is  very  limited  of  maintaining  the  nutrition 
of  this  organism,  without  reference  to  the  supplemental  wave 
of  nutrition,  and  to  the  occasional  stimulus  of  pregnancy,  in 
view  of  which  the  entire  economy  has  been  constructed.  It 
would  seem  as  if  in  the  uninterrupted  recurrence  of  menstru- 
ation, the  lesser  supplemental  wave  of  nutrition  gradually 
encroached  on  the  individual  nutrition  ;  precisely  as,  in  a  too 
frequent  recurrence  of  pregnancies,  we  have  seen  to  be  the 
case.  Our  attention  has  been  frequently  called  to  the  fact, 
that  in  unmarried  women  between  the  ages  of  twenty-eight 
and  thirty-five,  living  apparently  in  the  most  healthy  and 
admirable  conditions,  is  often  observed  a  general  failure  of 
strength  without  any  apparent  cause.  Unless  some  special 
predisposition  exists,  no  special  disease  is  developed,  (in  the 
case  we  are  considering,)  but  there  is  loss  of  flesh,  of  muscu- 
lar strength,  of  mental  energy,  diminished  appetite,  pallor, 

1  Duncan  shows  that  the  mortality  of  the  ninth  childbirth  rises  to  the  level  of 
that  of  the  first.  The  physical  conditions  of  many  women  at  a  ninth  pregnancy, 
which  favors  so  many  accidents,  uterine  inertia,  hemorrhage,  transverse  positions, 
septic  absortion,  is  however  often  reached  much  earlier,  even  at  the  fourth  or  fifth. 
The  essence  of  the  condition  lies  in  the  complete  exhaustion  of  muscular  tonicity. 


212  THE   QUESTION   OF   REST    FOR   WOMEN. 

backache,  anemic  blood,  often  neuralgia,  often  dyspepsia. 
In  these  cases  menstrual  disturbance  is  often  entirely  absent, 
but  at  other  times  the  milder  form  of  spasmodic  dysmenor- 
rhca  supervenes.  After  passing  through  a  period  of  three, 
four  or  five  years  in  this  condition,  the  health  gradually  im- 
proves, with  apparently  as  little  reason  as  it  had  deteriorated. 
We  have  acquired  the  habit  of  calling  these  cases,  "  pseudo- 
pregnancies."  They  are  sometimes  observed  much  earlier, 
three  or  four  years  after  leaving  school  or  college,  when  attend- 
ance has  been  prolonged  till  twenty  or  twenty-one,  and  it  is 
rather  the  fashion  then,  to  attribute  them  to  overwork  at 
college.  But  when  occurring  only  some  time  after  the  close  of 
college  life  independent  of  any  influence  of  adverse  circum- 
stances, of  local  disease  or  hereditary  predisposition,  we  believe 
they  are  to  be  explained  by  the  lack  of  stimulus  that  should 
be  derived  from  reproduction. 

So  predominant  is  this  necessity,  that  the  same  condition 
of  health  may  be  seen  in  the  women  who  are  married  but 
sterile.  These  however,  are  more  prone  to  local  disease  of 
the  uterus  or  ovaries.  While  assigning  to  the  necessity  for 
reproduction,  the  predominant  place  in  the  female  organism, 
the  importance  to  general  nutrition  of  the  physical  stimulus, 
derived  from  the  exercise  of  the  sexual  functions  must  not 
certainly  be  overlooked. 

It  cannot  be  said,  that  it  is  overlooked  by  the  physicians 
who  have  written  on  diseases  of  women  ;  but  many  arrange- 
ments of  society  in  modern  times,  seem  to  have  been  planned 
on  the  assumption  of  almost  the  complete  absence  of  such 
necessity. 

3.  The  last  effect  of  celibacy  and  sterility  we  have  to  con- 
sider, is  that  on  the  uterus  and  ovaries.  In  this  respect  while 
much  truth  has  been  perceived,  many  exaggerations  and  mis- 
statements  have  been  uttered.  Thus  Barnes  says,  "  That  the 
activities  of  the  ovaries,  uterus,  and  mammary  glands,  are 
intended  to  periodically  relieve  each  other  by  the  alternations 


CONDITION   OF   STERILE   UTERUS.  213 

of  ovulation,  pregnancy,  and  lactation."  We  have  seen  how- 
ever, that  the  development  of  ovules  by  no  means  necessarily 
ceases  during  pregnancy,  and  the  activity  of  the  mammary 
glands  is  of  too  short  duration  to  require  relief.  The  cessa- 
tion of  menstruation  during  lactation  however,  does  preserve 
the  uterus  in  a  more  quiescent  state  than  when  its  walls  are 
subjected  to  the  monthly  afflux  of  blood,  even  though  that 
only  passes  through  them,  and  does  not  accumulate  there. 
This  period  of  quiet,  necessitated  after  the  extra  nutrition  of 
pregnancy,  is  probably  desirable  on  other  grounds,  as  exclud- 
ing for  awhile  the  liability  to  stasis  and  congestion,  into 
which  the  menstrual  afflux  may  be  converted.  King's  idea, 
already  quoted,  that  the  non-pregnant  uterus  begins  to  suffer 
atrophy  by  sclerosis,  because  not  permitted  to  enter  upon  its 
functions,  is  unsupported  by  any  fact.  But  the  suggestion 
seems  to  contain  the  germ  of  an  important  truth  that  a  uterus 
which  never  has  been  impregnated,  remains  permanently  in  a 
rudimentary  condition  relative  to  its  type,  and  hence  par- 
tially unfit  to  meet  the  exigencies  of  a  period  of  life  at  which 
it  is  destined  to  be  more  highly  developed. 

The  degree  of  deficiency,  however,  can  only  be  slight,  as 
may  be  seen  by  comparing  with  some  other  imaginary  arrest 
of  development,  such,  for  instance,  as  should  make  the  milk 
teeth  persist  in  adult  life.  Nevertheless,  in  feeble  constitu- 
tions, or  under  special  influences,  this  degree  may  count  for 
much.  To  speak  precisely:  we  have  seen  that  normal  men- 
struation requires  a  rhythmic  painless  contraction  of  the 
muscular  fibres  of  the  uterine  wall,  by  means  of  which  the 
blood  shall  be  propelled  regularly  towards  the  cavity  of  the 
uterus.  If  now,  from  imperfect  vitality  or  regressive  struct- 
ure of  these  fibres,  their  contractility  be  deficient,  the  blood 
will  accumulate  in  the  parenchyma  of  the  uterus,  causing 
congestion  of  the  body  of  the  uterus.  This  disorder  is  cer- 
tainly much  more  frequent  in  sterile  women,  whether  married 
or  unmarried,  than  any  other  one  uterine  complaint ;  and 


2T4  THE    QUESTION    OF    REST    FOR    WOMEN. 

admittedly  more  so  than  in  women  who  have  borne  children, 
in  whom  disease  of  the  cervix  predominates.1  Such  deficient 
contractility  of  uterine  fibre  is  the  cause  of  that  form  of  men- 
strual pain  which  consists  in  pelvic  weight  and  heaviness. 
It  is  equivalent,  in  the  menstrual  cycle,  to  the  uterine  inertia 
of  the  parturient  cycle,  which  is  the  cause  of  so  many,  and 
sometimes  such  terrific,  disasters. 

In  addition  to  this  deficient  contractility  of  uterine  fibre, 
Chapman '  points  out  that  from  the  density  and  resistance 
of  the  parenchyma  of  the  nulliparous  uterus,  any  undue 
accumulation  of  blood  must  cause  much  more  irritation  than 
in  the  yielding  tissues  of  the  multiparous  uterus,  from 
greater  compression  of  nerves.  Moreover,  the  blood  is  more 
likely  to  be  "  dammed  up  towards  the  ovaries,"  and  so  call 
into  fiendish  activity  the  normally  obtuse  sensibility  of  these 
organs.  If,  under  these  circumstances,  the  complete  regres- 
sion of  the  menstrual  decidua  be  arrested,  it  will  persist  as 
the  sensitive,  hyperasmiated  endometrium  of  endometritis. 
Corporeal  endometritis  and  ovaritis  are  diseases  again,  which 
relatively  to  cervical  inflammation,  are  admitted  to  be  very 
much  more  frequent  in  sterile  women  than  in  others.  Out 
of  thirteen  cases  of  uterine  disease  in  nulliparous  women, 
other  than  functional,  or  dependent  on  congenital  predisposi- 
tion or  defects  of  structure,  which  have  recently  fallen  under 
the  writer's  observation,  there  were  nine  such  cases. 

From  this  review  of  the  possible  consequences  of  celibacy, 
it  must  be  evident  that  they  must  be  taken  into  account  in 
every  estimate  made  of  the  working  capacity  of  women,  and 
that,  when  a  woman  engaged  in  any  employment,  deteriorates 
in  her  general  or  uterine  health,  it  is  necessary,  before 
ascribing  the  breakdown  to  the  work,  to  carefully  eliminate 
the  influence  of  this  wide-spread  cause  of  evil. 

It  happens,  moreover,  that  in  this  country  the  women  who 

1  Cases  of  subinvolution  of  course  excepted,  and  results  of  prolapsus,  etc. 
9  Diseases  of  Women.  New  York,  1874. 


CONGENITAL   DYSMENORRHEA.  21$ 

escape  these  dangers  by  marriage  and  childbearing,  do  not 
utilize  their  increased  vitality  in  labor  other  than  domestic. 
We  have  seen  that  one-seventh  of  the  married  women  of 
Great  Britain  do  work. 

Fortunately  in  practice,  and  as  shown  by  our  statistics, 
many  of  the  evils  threatened  by  celibacy  are  never  really 
produced,  and  to  this,  as  to  other  conditions  imposed  by  the 
social  organism,  the  human  organism  shows  a  marvellous 
power  of  adapting  itself.  As  already  noticed,  these  consider- 
ations in  regard  to  the  pathological  influence  of  sterility  are 
of  course  not  intended  to  shut  out  of  sight  the  morbid  con- 
ditions that  may  result  from  parturition.  But  these  are 
foreign  to  our  subject,  which  is  confined  to  menstruation  in 
women  presumably  healthy. 

In  regard  to  other  causes  of  acquired  menstrual  pain, 
such  as  sudden  suppression  of  the  flow  through  exposure  to 
cold,  nervous  excitement,  etc.,  it  is  unnecessary  to  say  any 
thing  in  this  essay,  for  so  much  has  been  said  elsewhere.  Of 
course  all  influences  capable  of  suddenly  checking  the  uterine 
hemorrhage,  can  only  operate  during  that  period  of  the  men- 
strual cycle.  Such  sudden  suppression  may  unquestionably 
become  the  starting  point  of  chronic  uterine  congestion  or 
inflammation.  But  these  accidents  are  confessedly  due  to 
causes  acting  suddenly,  and  exceptionally,  to  unusual  emer- 
gencies, in  a  word.  Hence  again,  they  have  little  to  do  with 
the  question  of  habitual  occupation  or  work. 

We  have  dwelt  so  long  upon  the  first  form  of  menstrual 
pain,  that  we  may  pass  quite  cursorily  over  the  others.  In 
regard  to  the  second  spasmodic  pain  of  very  great  intensity, 
setting  in  with  the  first  establishment  of  menstruation,  it  is 
certain  that  this  depends,  in  the  great  majority  of  cases, 
upon  local  anatomical  conditions,  interfering  with  the  egress 
of  blood  from  the  uterus.  These  are  well  known  to  be, 
stricture  of  the  os  flexion,  deformity  of  the  cervix.  They 
nearly  always  imply  a  defective  development  of  the  organs  of 


2l6  THE   QUESTION   OF   REST   FOR   WOMEN. 

veneration,  except  in  a  few  cases  where  a  local  peritonitis, 
preceding  menstruation,  has  caused  flexion  by  means  of 
uterine  adhesions.  One  of  the  most  severe  cases  of  primary 
dysmcnorrhea  represented  on  our  tables,  is  that  of  a  young 
German  servant,  in  whom  this  accident  had  occurred.  Out 
of  six  cases  of  stricture  of  the  os  without  flexion,  all  nulli- 
parous  (two  married  and  four  unmarried,)  women,  in  three  the 
uterus  measured  less  than  six  centimetres  in  length.  In  one 
of  these  cases  (married  and  sterile),  there  was  no  pain  at 
menstruation,  because  (probably)  this  was  so  scanty.  The 
patient  was  remarkably  small,  the  deficient  development  of 
the  uterus  seeming  to  be  shared  by  the  entire  physique.  In 
another,  on  the  contrary,  the  patient  was  remarkably  tall, 
but  preserved  a  certain  childishness  of  character  and  appear- 
ance. Here  the  development  of  the  organs  of  generation 
had  remained  behind  that  of  the  rest  of  the  body.  It  is  well 
known  that  after  menstruation  has  persisted  during  some 
years,  while  the  os  is  contracted,  congestion,  inflammation, 
flexion,  or  even  hypertrophy  of  the  uterine  body,  is  frequently 
induced  by  the  violence  of  the  repeated  menstrual  efforts  at 
expulsion.  Even  spasmodic  stricture,  existing  during  the 
first  years  of  menstruation  in  the  neurotic  cases  already  de- 
scribed, may,  by  inducing  undue  tumefaction  of  the  endome- 
trium,  entail  the  results  of  organic  stricture.  The  same 
result,  from  undue  hyperaemia  of  the  uterus.  It  is  the  latter 
condition,  and  that  of  organic  stricture  or  of  congenital 
flexion,  which  most  often  explain  the  dysmenorfhea  in  young 
girls  of  otherwise  sound  health,  and  who  had  passed  a  vigor- 
ous childhood,  but  who  are  too  often  destined  to  break  down 
after  puberty  as  miserable  invalids.  Unfortunately  the  pre- 
cise cause  of  these  anatomical  deficiencies  upon  which  such 
grave  consequences  will  depend,  at  present  escapes  us,  so 
that  the  prophylactic  measures  that  might  be  carried  out 
during  childhood,  and  which  are  so  efficacious  against  other 


CONGENITAL   DYSMENORRHEA.  2  I/ 

forms  of  dysmenorrhea,  are  here  too  often  powerless.1  *  But 
these  cases  are  very  frequently  cured  by  marriage,  when  con- 
ception takes  place,  which  is  by  no  means  always  hindered 
by  the  same  conditions  which  in  other  cases  may  appear  to 
be  the  sole  cause  of  sterility.  If  the  marriage  takes  place 
early  enough,  the  uterus  may  continue  to  develop  after  it, 
and  hence  the  results  of  its  imperfect  development  gradually 
disappear.  But  when  this  does  not  occur,  or  when  celibacy 
or  sterility  exclude  the  natural  cure  of  the  consequences  of 
premature  menstruation/  we  still  possess  efficacious  resources 
in  medical  and  surgical  treatment.  The  introduction  of 
various  methods  for  treatment  of  stricture  and  flexion  that 
have  only  recently  been  popularized,  is  a  fact  that  should 
radically  change  the  lives  of  thousands  of  women.4  Of 
course  there  are,  as  it  is  superfluous  to  observe  in  this  place, 
many  cases  where  such  treatment  is  quite  unavailable,  but 
the  appropriate  cases  are  really  extremely  numerous,  and 
success  of  treatment  is  often  proportioned  to  its  early  date. 
Each  such  patient  restored  to  health  by  a  technical  opera- 

1  The  large  proportion  of  cases  noted  in  our  Table  of  primary  dysmenorrhea 
where  the  education  was  limited  to  "common  English,"  shows  that  these  cases 
abound  in  classes  of  society  where  the  childhood  is  less  cared  for  than  in  wealthier 
classes,  and  less  nutriment  provided  for  the  growing  body. 

2  Except  as  all  measures  tending  to  secure  an  equable  development  of  the 
body  may  influence  the  special  development  of  the  uterus. 

3  Premature,  that  is,  in  comparison  with  the  development  of  the  uterus.     It  is 
very  noticeable  that  in  peasant  girls,  if  somewhat  cMoro  anemic  and  ill  devel- 
oped, menstruation  is  often  delayed  till  eighteen  or  nineteen,  and  then  sets  in 
without  pain  ;  but  in  the  upper  classes,  especially  of  girls   living  in  cities,  while 
the  general  nutrition  of  the  body  is  still  imperfect,  and  its  development  incom- 
plete, menstruation  nevertheless  occurs  at  the  usual  age,  but  with  great  suffering. 
Here  it  is  evident  that  the  reproductive  system  is  forced  into  a  precocious  devel- 
opment as  compared  to  that  of  the  individual,  even  although  its  establishment 
appears  to  be  at  the  most  normal  time.     Hence  certainly  many  cases  of  organic 
primary  dysmenorrhea. 

4  As  decidedly  as  Bonder's  treatment  of  hypermetropia  by  convex  glasses  has 
changed  the  existence  of  thousands,  who  were  formerly  condemned  to  disappoint- 
ment or  misery  by  the  vague  diagnosis,  "  weak  eyes." 


2l8  THE    QUESTION    OF    REST    FOR    \YO.MEX. 

tion,  is  a  permanent  witness  to  the  folly  of  attempting  to 
explain,  still  more  to  rectify,  women's  sufferings  by  senti- 
mental and  empty  generalizations  on  the  abstract  nature  of 
the  female  sex.  It  would  be  as  rational  to  treat  any  other 
infirmity  dependent  on  anatomical  imperfections  upon  prin- 
ciples derived  from  Pascal's  lofty  aphorisms  concerning  the 
nature  of  man  ! 

Finally  for  the  purpose  of  this  essay,  it  is  most  important 
to  notice,  that  in  this  class  of  cases,  rest  during  menstruation 
is  generally  necessitated,  and  the  patient  has  no  choice  in  the 
matter.  But  on  the  other  hand,  that  such  rest  has  no  influ- 
ence in  preventing  a  recurrence  of  pain,  or  the  development 
of  the  usual  train  of  morbid  symptoms.  All  that  can  be  said 
is,  that  uterine  congestion  may  be  aggravated  by  exertion, 
and  this  consequently  is  to  be  avoided.  The  patient  is  not 
a  type  of  a  menstruating  woman,  but  a  sick  person,  and  to  be 
treated,  when  possible,  accordingly. 

Referring  now  to  the  sixth  proposition  on  p.  193,  we  en- 
counter a  third  class  of  cases,  of  much  deeper  pathological 
significance.  In  these,  premenstrual  pain  exists,  and  the 
menstrual  pain  is  burning,  not  cramp  like.  In  such  persons 
it  is  certain  that  the  hyperaemia  of  the  uterine  ovarian  plexus, 
demonstrated  to  precede  menstruation,  is  either  excessive, 
or  the  innervation  of  uterus  and  ovaries  so  perverted  that 
even  the  normal  afflux  of  blood  and  increased  rapidity  of 
circulation  causes  irritation  instead  of  the  normal  stimulus ; 
or  the  assimilated  capacity  of  their  tissue  elements  is  so  de- 
pressed, that  these  are  unable  to  appropriate  increased  nutri- 
ment offered  by  the  increased  blood  supply,  and  hence  here 
as  elsewhere,  increased  blood  pressure,  unaccompanied  by 
increased  nutritive  or  functional  activity  of  the  tissues  in 
which  it  exists,  causes  pain.  We  have  already  noticed  some 
of  the  results,  if  the  motor  forcj,  the  contractility  of  the 
uterine  fibres,  fail  to  be  temporarily  increased  by  the  tem- 
porary increase  in  the  energy  of  their  circulation.  If  the 


PREMENSTRUAL   PAIN.  2 19 

deficiency  be  carried  farther  than  in  the  first  class  of  cases, 
blood  accumulates  in  the  uterine  walls  instead  of  being  pro- 
pelled towards  the  surface  of  the  mucous  membrane,  hence  a 
real  congestion,  instead  of  the  superficial  hyperaemia  which 
is  normal.  According  to  the  intensity  with  which  these 
causes  operate,  we  have  all  degrees  of  morbid  states,  from 
simple  congestion  to  chronic  metritis,  endometritis,  ovaritis. 

The  intermenstrual  pain,  beginning  two  weeks  before  the 
menstrual  period,  has  been  associated  by  many  with  the  com- 
mencement of  periodical  ovulation.  It  seems  indeed  probable 
that  wherever  the  parenchyma  of  the  ovary  is  morbidly 
hyperaemiated,  as  in  this  class  of  cases,  that  the  ripening  of 
the  Graafian  follicle  would  have  the  same  effect  as  the  growth 
of  the  tooth  follicle  in  a  hyperaemiated  gum.  Although  we 
cannot  admit  pressure  upon  the  peritoneum,  yet  pressure  upon 
the  stroma,  perhaps  from  over  distension  by  an  excess  of 
Liquor  folliculi  or  undue  prolongation  of  the  period  preceding 
the  rupture,  is  theoretically  capable  of  inducing  such  irritation. 
The  analogy  between  the  tooth  follicles  and  the  Graafian 
follicles  is  great,  and  the  irritation  that  may  be  produced 
coincidently  with  their  development  on  the  nervous  systems  of 
the  woman  and  of  the  child,  offer  many  points  of  resemblance. 

From  what  we  have  said  before,  it  is  evident  that  we  do 
not  admit  a  precise  coincidence  between  this  special  time  of 
the  intermenstrual  period,  and  the  maturation  of  any  one 
Graafian  vesicle  as  often  as  has  been  supposed.  But  from  the 
evidence  before  us,  it  seems  at  least  not  improbable,  that  in 
certain  individuals  this  coincidence  is  exact,  and  that  this 
peculiar  premenstrual  pain  depends  not  only  on  the  utero 
ovarian  hyperaemia,  (morbidly  converted  into  congestion)  but 
also  on  morbid  development  of  an  ovule. 

All  these  symptoms  indicate  utero-ovarian  disease  of 
very  varying  degrees  of  severity,  but  all  requiring  treatment. 
It  is  in  these  cases  that  rest  is  most  imperatively  needed,  pre- 
cisely because  it  is  most  apt  to  be  neglected  in  all  cases  where 


22O  THE    QUESTION    OF    REST    FOR    WOMEN". 

the  pain  is  not  extremely  severe.  It  must  never  be  forgotten, 
that  the  significance  of  menstrual  pain  is  less  in  proportion 
to  its  degree,  than  to  its  kind,  its  duration,  and  its  cor- 
respondence \vith  certain  stages  of  the  menstrual  process. 
Six  hours'  violent  cramp,  if  unconnected  with  organic  defect 
of  the  uterus,  is  of  less  importance  than  moderate  endurable 
pain,  which  begins  a  week  before  the  menstrual  flow,  con- 
tinues throughout  it,  and  leaves  the  patient  for  several  days 
bruised  and  fatigued.  This  latter  indicates  nutritive  disease, 
although  possibly  of  a  low  grade. 

There  is  another  form  of  premenstrual  suffering  that  is  en-    ( 
tirely  different  from  the  above  described.     It  consists,  not  in 
a  local  pain,  but  in  general  uneasiness,  excitability,  often  head- 
ache, dyspepsia,  or  even  fever.    These  symptoms  depend  upon  ; 
the  increased   vascular  tension,  and  increased  blood  pressure 
upon  nerve  centres  possessing  deficient  powers  of  resistance. 

These  effects  of  the  general  rise  of  the  vascular  tension 
resemble  the  local  phenomena  previously  described  as  de- 
pendent on  the  local  rise  of  tension  in  the  blood  vessels  of 
the  pelvis.  They  are  identical  with  the  symptoms  observed 
in  many  cases  of  amenorrhea,  where  the  supplemental  wave 
of  nutrition  seems  to  rise  high  enough  to  increase  the  gen- 
eral vascular  tension,  but  not  enough  to  rupture  the  uterine 
bloodvessels;  or  where  this  is  rendered  impossible  by  defi- 
cient development,  or  deficient  fatty  degeneration  of  the 
menstrual  decidua.  Two  of  our  cases  of  prolonged  amenor- 
rhea showed  the  effects  of  blood  pressure  on  nerve  centres, 
excessive  relatively  to  their  power  of  resistance,  in  a  very 
marked  manner.  In  one  of  these  cases,  the  girl  had  suffered 
from  severe  chorea  every  summer  for  three  years  in  succes- 
sion, from  the  age  of  thirteen  to  sixteen.  She  menstruated 
from  fourteen  to  fifteen,  afterwards  once  at  eighteen,  then 
not  again,  except  once  while  under  treatment,  until  twenty- 
two.  She  was  neurotic,  and  extremely  fat,  with  the  anemia 
characteristic  of  fat  girls.  So  long  as  menstruation  was  not 


INCREASED    MENTAL   ENERGY  AT   MENSTRUATION.       221 

established,  she  suffered  extremely  from  tympanites  of  the 
bowels,  rapidly  developed  after  eating.  After  some  entirely 
unsuccessful  treatment,  including  electrical  applications, 
leeches  were  applied  once  a  month  to  the  cervix  uteri.  On 
each  occasion,  for  three  months  in  succession,  the  bleeding 
from  the  leech  bites  ceased  in  a  few  hours,  to  be  followed  in 
two  or  three  days  by  a  regular  hemorrhage.  From  the  first 
occasion  on  which  this  occurred,  the  tympanites  ceased,  and 
the  superfluous  fat  began  to  rapidly  diminish. 

In  another  case,  where  menstruation  was  regular,  the 
patient  had  also  suffered  from  chorea,  indeed  from  the  age 
of  ten  to  that  of  fourteen  without  interruption.  For  ten 
days  before  menstruation  she  habitually  suffered  from  tym- 
panites, headache,  flushes,  ringing  in  the  ears,  etc.  As  soon 
as  the  flow  set  in,  all  unpleasant  symptoms  disappeared>  and 
she  felt  extremely  well.  She  had  no  trace  of  utero  ovarian 
disease,  but  at  the  time  the  above  symptoms  were  detailed 
to  me,  suffered  from  cardiac  hypertrophy  and  double  valvu- 
lar disease,  the  result  of  two  attacks  of  rheumatism.  Here 
two  conditions  of  distress  existed,  the  cardiac  hypertrophy, 
exaggerating  the  normal  increase  of  tension,  and  the  imperfect 
nutrition  of  the  nerve  centres,  already  indicated  by  the  chorea. 

On  the  other  hand,  it  is  in  a  normal,  or  even  slightly 
anemic  condition  of  the  nerve  centres,  that  an  increase  of 
health  and  energy  is  experienced  during  the  premenstrual 
week.  This  is  true,  although  at  the  same  time  the  most 
complex  nutritive  processes  are  being  effected  in  the  uterus, 
and  sometimes  in  the  ovary  also.  This  fact  alone  demon- 
strates that,  in  a  complex  organism^  the  general  law  of 
balance  between  functional  activities  of  different  organs  does 
not  imply  that  temporary  increase  in  the  nutrition  of  one 
must  determine  a  deficiency  in  the  nutrition  of  the  others, 
sufficiently  marked  to  be  perceptible  to  consciousness.  In  cer- 
tain cases  of  impaired  nutrition  of  nerve  centres,  unaccom- 
panied by  vaso  motor  paresis,  or,  therefore,  by  menorrhagia 


222  THE    QUESTION    OF    REST    FOR    WOMEN. 

(such  conditions  frequently  constitute  the  basis  of  hysteria),  the 
increased  feeling  of  energy  begun  during  the  premenstrual  week 
is  extended  throughout  the  menstrual  flow.  We  have  related 
the  history  of  one  such  case  where  this  circumstance  was 
extremely  marked.  The  increase  in  mental  energy  in  such 
persons  is  often  remarkable,  and  offers  a  miniature  resem- 
blance, on  account  of  its  etiology,  to  certain  forms  of  "  circular 
insanity."  For  the  nutrition  of  the  brain  centres  is  habitually 
below  par,  and  their  activity  consequently  weak ;  but  under 
the  increased  blood  pressure  and  rapidity  of  circulation  of 
the  pre-menstrual  period,  this  is  raised  to  normal  intensity. 
In  the  pathological  cases,  the  activity,  raised  above  the  normal 
point,  and  perverted,  constitutes  mania.  Moreau  (Psycho- 
logic morbide)  relates  cases,  observed  in  both  sexes,  where 
periods  of  semi-idiocy  regularly  alternated  with  periods  of 
considerable  literary  talent.  During  the  first,  the  circulation 
was  sluggish,  during  the  second,  accelerated. 


CONCLUSIONS. 

HAVING  exhausted  the  material  we  have  been,  on  this 
occasion,  able  to  collect  for  observation  or  reasoning 
in  regard  to  the  question  considered  by  this  essay,  we 
may  now  sum  up  the  conclusions  which  we  believe  may  be 
legitimately  derived  from  its  analysis.  These  conclusions 
may  be  best  summarized  in  the  form  of  answers  to  the  ques- 
tions propounded  on  pp.  193-194. 

i.  When  pain  exists  from  the  first  menstruation  it  de- 
pends upon :  (a)  Imperfect  power  of  resistance  in  the  nerve 
centres,  which  renders  them  unduly  susceptible  to  the  excite- 
ment of  the  increased  vascular  tension  that  prepares  the  men- 
strual flow.  This  excitement  may  be  in  itself  a  cause  of  gen- 
eral disturbance,  or  be  followed  by  exhaustion,  which  is 
necessarily  accompanied  by  vaso  motor  irritation,  hence  local 
disturbance  in  the  circulation  of  the  uterine  walls,  and  conse- 
quent atonic  contractions  of  its  fibre,  (ft)  Disproportion 
between  the  development  of  the  uterus  and  that  of  the  rest 
of  the  body,  resulting  in  various  organic  defects  of  the  genital 
canal.  The  proximate  cause  of  such  disproportion,  in  the 
actual  state  of  science,  often  escapes  us.  But  in  a  certain 
class  of  cases,  there  is  reason  to  accuse  a  precocious  comple- 
tion of  development  of  the  central  nervous  organs,  especially 
those  of  the  cranial  cavity,1  and  an  equally  precocious  dim- 
inution of  muscular  activity.  On  both  accounts  the  moment 
is  early  attained  at  which  the  muscles  assume  the  habit  of 
rejecting  a  certain  proportion  of  nutriment,  in  order  to 

1  We  follow  Brown-Sequard  in  using  this  expression  instead  of  the  collective 
term  brain. 


224  THE   QUESTION    OF    REST  FOR   WOMEN. 

provide  for  the  development  of  the  supplemental  wave. 
Individual  nutrition  is  arrested,  reproductive  nutrition 
commences  before  the  organs  of  the  individual  have 
been  properly  elaborated,  and  before  the  organs  of  repro- 
duction have  been  sufficiently  developed.  Hence  a  double 
cause  of  disorder  and  suffering,  whose  frequence  is  in 
direct  proportion  to  the  prevalence  of  habits  of  luxury  and 
of  purely  ornamental  education.1  (r)  Menstrual  pain  on  the 
contrary  is  acquired  either  by  the  acquisition  of  the  states  of 
imperfect  nutrition,  which  in  the  first  cases  are  congenital  or 
developed  during  childhood  ;  or  by  the  continual  aggravation 
of  the  effects  of  the  local  organic  imperfections,  whose  influ- 
ence was  at  first  slight ;  or  finally  in  consequence  of  organic 
utero  ovarian  disease.  The  first  and  third  cases  may  result 
from  various  accidents  common  to  the  genesis  of  any  disease 
in  either  sex;  but  also  from  two  causes,  very  much  more 
frequently  operative  in  women  than  men,  namely,  ill-arranged 
work  and  celibacy  ;  finally  from  a  third  class  of  causes, 
necessarily  peculiar  to  women,  sudden  suppression  of  men- 
strual hemorrhage,  or  the  accidents  of  pregnancy  and  parturi- 
tion. These  last  again  are  not  in  equal  relation  to  all  forms 
of  menstrual  pain,  or  uterine  disorder  that  may  have  existed 
before  marriage  ;  their  liability  is  very  much  increased,  in 
any  case  where  the  contractility  of  uterine  fibre  has  become 
deficient  or  exhausted  during  repeated  menstruations.  It  is 
true,  therefore,  to  say,  that  in  certain  cases,  prolonged  celi- 
bacy or  sterility,  has  been  the  real  cause  of  the  accidents  of 
parturition,  and  that  the  physiological  necessity  for  repro- 
duction, existing  to  a  greater  or  less  extent  in  all  women,  is 
very  much  more  imperious  and  earlier  imposed  in  some 
women  than  in  others.2 

'All  authors  agree  on  the  evils  of  premature  menstruation,  but  we  have  not 
seen  these  connected  in  the  above  manner  with  the  genesis  of  neurotic  disorder, 
and  of  organic  uterine  disease. 

'•'  It  is  infinitely  probable  that  the  time  at  which  this  necessity  is  first  felt  by 
the  organism  (if  we  may  so  speak)  is  very  much  modified,  as  are  all  circumstances 


CAUSES   OF   MENSTRUAL   TAIN.  225 

2.  When  persons  in  good  health  suffer  severe  menstrual 
pain,  this  is  nearly  always  dependent  upon  some  anatomical 
imperfection  of  the  uterus.     Like  many  other  congenital  im- 
perfections, this  may  originally  appear  a  mere  trifle  in  the 
sum  of  organic  development,  yet  from  the  peculiar  circum- 
stances of  the   case,   its  results  may  assume  gigantic  pro- 
portions. 

When  persons  in  delicate  health  are  free  from  menstrual 
distress,  it  is  because  the  supplemental  wave  of  nutrition 
does  not  rise  sufficiently  to  greatly  increase  general  vascular 
tension,  or  because  the  uterus  is  too  slightly  hypersemiated 
to  excite  reaction.  We  believe  we  have  observed,  though  as 
yet  have  no  statistics  to  prove  it,  that  the  chlorotic  or  con- 
sumptive girls  who  have  suffered  pain  before  marriage,  sus- 
tain their  first  pregnancy  better,  or  are  even  improved  by  it 
more,  than  those  in  whom,  with  equally  low  individual  nutri- 
tion, the  supplemental  wave  had  been  too  defective  to  cause 
irritation. 

3.  That  46  per  cent,  of  the  women  we  have  examined 
suffer  more  or  less  disturbance  at  menstruation,  is  a  fact  cer- 
tainly connected  with  the  habits  of  civilized  life  and  the  very 
slender  provision  made  for  the  physical  education  of  girls, 
especially  for  the  development  of  their  muscular  nutrition. 
No  anatomical  or  physiological  condition  revealed  to  us  by 
the  impartial  analysis  of  the  series  of  phenomena  constituting 
the  entire  menstrual  process,   is  necessarily  productive  of 
suffering.     On  the  contrary,  we  discover  in  these  rhythmic 
waves  of  nutrition,  as  in  the  larger  waves  of  gestation,  re- 
markable provisions  for  rhythmically  (we  cannot  say  period- 
ically)  increasing   nutrition   and    the   vital    energy   of    the 
woman.     These  provisions  should  serve  to  compensate  for 
the  deficiency  in  the  stimulus  afforded  by  muscular  activity. 

of  reproduction,  by  the  social  medium.     For   the  age  of  marriage  is  constantly 
receding,  or  at  all  events,  marriages  formerly  called  "late"  are  becoming  more 
and  more  frequent. 
15 


226  THE   QUESTION    OF    REST    FOR    WOMEN. 

The  social  perversions,  by  which  these  processes  so  often 
deteriorate  what  they  are  naturally  adapted  to  improve,  arc  : 
Bad  physical  education  during  childhood  and  adolescence;1 
absence  of  employment,  or  work  that  is  either  absolutely 
excessive  or  excessive  relative  to  woman's  constitution,  by 
being  prolonged  too  much  during  a  single  session,  or  else 
which  is  insufficiently  relieved  by  recreation  or  insufficiently 
spurred  by  interest ;  unduly  prolonged  celibacy,  and  unequal 
distribution  of  reproduction,  on  account  of  which  many 
women  are  broken  down  by  excessive  child-bearing,  while 
main-  others  never  obtain  the  opportunity  to  bear  a  single 
child,  for  which,  nevertheless,  every  fibre  of  their  physical 
and  moral  being  is  yearning. 

4.  The  danger  of  disregarding  menstrual  pain  when  it 
exists,  varies  with  its  proximate  causes.  Purely  spasmodic 
pain  of  moderate  intensity,  may  be,  and  certainly  is,  tolerated 
in  an  immense  majority  of  cases,  far  better  while  the  ordinary 
occupations  arc  continued.  The  tables  show  this.  Pain 
from  organic  defect,  or  from  local  nutritive  disorder  (conges- 
tion, inflammation),  should,  wherever  it  be  possible,  claim 
rest ;  but  this  will  not  cure  the  pain,  unless  special  treatment 
be  instituted.  The  only  cases  where  rest  really  cures  or  pre- 
vents menstrual  pain,  arc  those  where  general  debility  is  so 
marked  that  the  loss  of  blood  at  menstruation  is  sufficient  to 
lower  the  nutrition  of  the  nerve  centres  below  the  level  to 
which  they  are  capable  of  generating  force  with  ease.  In 
sach  case,  any  expenditure  of  force  weakens  them  still  fur- 
ther, and  vaso  motor  irritation  and  uterine  cramps  are  the 
result.  Such  persons  may  feel  perfectly  comfortable  during 
the  menstrual  flow,  while  inactive,  but  excitement  or  exertion 
of  body  or  mind  brings  on  pain.  In  them  the  supplemental 
wave  of  nutrition  has  been  insufficient,  yet  the  hemorrhage, 

1  It  is  curious  to  notice  how  the  effects  of  misery,  and  the  effects  of  luxury, 
during  the  childhood  of  a  girl,  are  found  so  often  to  result  in  an  identical  mode 
of  stunted  development  in  adolescence. 


DANGER   OF   MENSTRUAL   PAIN.  22/ 

once  commenced,  is  continued  by  habit  and  relaxation  of 
tissues ;  the  deficiency  is  supplied  from  the  blood  needed  for 
the  individual  nutrition. 

5.  The  fifth  question  is  answered  by  all  that  precedes, 
and  especially  by  the  last  paragraph.  There  is  nothing  in  the 
nature  of  menstruation  to  imply  the  necessity,  or  even  the 
desirability,  of  rest,  for  women  whose  nutrition  is  really 
normal.  The  habit  of  periodical  rest,  in  them,  might  indeed 
easily  become  injurious,  because  in  the  cessation  of  nervo 
muscular  activity,  the  blood  properly  attracted  to  the  mus- 
cles and  nerve  centres  would  be  diverted  from  them,  and 
tend  towards  the  pelvis,  increasing  its  hyperaemia  above  the 
physiological  standard.  Many  cases  of  pelvic  congestion, 
developed  in  healthy  but  indolent  and  luxurious  women,  are 
often  due  to  no  other  cause. 

The  reasoning  which  would  attempt  to  show  the  existence 
during  the  menstrual  flow  of  a  cerebro-spinal  excitement, 
determined  by  "  ovarian  irritation,"  incompatible  with  cerebro- 
spinal  activity,  is  entirely  fallacious,  and  based  on  false  anal- 
ogies, especially  with  those  of  the  rut.  The  menstrual  flow 
is  the  least  important-  part  of  the  menstrual  process,  and 
arguments  for  rest  drawn  from  the  complexity  of  the  physi- 
ological phenomena  involved  in  this,  should  logically  demand 
rest  for  women  during  at  least  twenty  days  out  of  the  twenty- 
eight  or  thirty.  In  other  words,  should  consign  them  to  the 
inactivity  of  a  Turkish  harem,  where  indeed,  anemia,  if  not 
dysmenorrhea  is  said  to  be  extremely  frequent. 

In  the  line  of  thought  pursued  throughout  this  essay,  the 
writer  has  held  in  view  the  demands  for  exertion  made  by 
industrial  labor,  or  by  any  such  employments,  as  clerkships,  or 
teaching  in  average  schools,  as  cannot  be  considered  to  in- 
volve any  decided  mental  labor.  Indeed,  if  the  question  pro- 
posed by  the  committee  be  regarded  merely  from  the  point 
of  view  of  the  statistics  of  the  census,  we  might  be  sur- 
prised that  the  clause  relating  to  mental  rest  had  been 


228  THE   QUESTION   OF    REST   FOR   WOMEN. 

inserted.  This  clause  is  evidently  intended  to  cover  the 
position  of  women  in  school  or  college,  in  the  professions, 
finally  in  any  pursuit  of  independent  responsibility,  where  at 
any  moment  may  be  required  the  exertion  of  independent 
judgment,  thought,  and  will.  The  clause  may  indeed  be 
intended  to  meet  either  negatively  or  affirmatively,  a  rather 
widely  diffused  sentiment  in  regard  to  women's  capacity  for 
such  independent  responsibilities.  The  habitual  modesty  of 
American  speech  often  enforces  silence  in  regard  to  the  fact 
upon  which  this  sentiment  is  supposed  to  be  based,  but  from 
time  to  time  the  silence  is  broken,  and  it  is  plumply  asserted, 
that  "  during  the  temporary  insanity  of  menstruation,"  ' 
female  judgment  is  unreliable,  even  unsafe,  because  no  form 
of  mental  action  can  be  adequately  carried  on  at  this  time. 
It  must  follow,  therefore,  that  no  duties  as  those  of  law  or 
medicine  for  instance,  for  whose  fulfillment  the  woman  is 
liable  to  be  called  upon  during  this  critical  period,  should 
ever  be  assumed  by  her.  Justice  to  the  public,  if  not  to  her- 
self, demands  that  she  should  be  peremptorily  excluded  from 
such  responsible  fields  of  action,  even  when  her  own  ill-starred 
ambition  may  lead  her  to  invade  them.  Among  all  the  facts 
we  have  examined,  there  is  but  one  group  that  might  seem  to 
justify  the  theory,  that  mental  rest  was  imperative  for  women 
in  menstruation,  whatever  might  be  the  case  with  physical. 
We  have  seen  that  alterations  of  pressure  exerted  in  the  brain, 
by  varying  degrees  of  vascular  tension,  may  cause  the  most 
extraordinary  alterations  in  its  functional  activity  and  capa- 
city for  function,  and  a  cardinal  point  in  this  essay  has  been 
the  attempt  to  show  that  in  women  exist  certain  fixed  altera- 
tions of  vascular  tension,  over  and  above  those  common  to 
the  physiological  processes  of  the  two  sexes.  But;  ist. 
These  alterations  succeed  each  other  so  gradually  that  the 
brain  sustains  no  shock  for  them.  2d.  The  rise  in  tension, 
which  presumably  should  affect  the  brain,  does  not  occur 
1  See  our  former  quotations. 


NERVOUS   PHENOMENA  OF   MENSTRUATION.  229 

during  the  menstrual  hemorrhage,  which  is  the  single  period- 
covered  by  the  question  of  the  committee.  3d.  Granted  that 
the  brain  is  stimulated  by  increased  vascular  tension,  it  is 
certain  that  when  any  habit  of  susceptibility  has  once  been 
established,  it  counts  in  the  ordinary  working  of  the  organ. 
4th.  The  reactions  of  the  brain  to  alterations  of  blood 
pressure  are  proportionate  not  only  to  them,  but  to  the 
degree  of  resistance  of  its  own  tissues.  Our  statistics  show 
that  53  per  cent,  out  of  two  hundred  and  sixty-three  women 
interrogated  at  hazard,  exhibit  such  a  degree  of  resistance  in 
their  nerve  tissues  as  to  enable  them  to  bear  with  impunity 
the  increased  vascular  tension  of  the  premenstrual  week.  It 
is  equally  certain,  however,  that  the  reverse  holds  in  a  large 
number  of  cases,  though  by  no  means  in  the  46  per  cent,  of 
our  tables.  It  is  Avhen  the  nutrition,  and  hence  the  vital 
resistance  of  the  nerve  centres  has  been  diminished,  that  the 
rise  in  tension  irritates  nerve  elements,  and  all  degrees  of 
nervous  erethism  may  be  produced,  from  ill  temper  to  in- 
sanity. Berthier1  (already  referred  to)  has  collected  a  large 
number  of  cases  where  the  approach  of  menstruation  was 
heralded  by  various  forms  of  neurotic  disorders — excitement, 
•epilepsy,  hysteria,  mania.  But  his  list  is  burdened  with 
many  cases,  quite  irrelevant,  where  the  outbreak  of  the  ner- 
vous disease  coincided  with  a  suppression  of  menstruation, 
and  hence  was  due,  either  to  the  abrupt  pathological  increase 
of  vascular  tension  (where  the  suppression  was  sudden),  or  to 
the  same  disorder  of  nutrition  as  had  caused  the  amenorrhea 
(in  gradual  cases).  Similarly,  all  treatises  on  nervous  or 
mental  disorders  are  crowded  with  cases  showing  that  the 
menstrual  periods  are  frequently  preceded  by  exacerbations 
of  the  disease.  We  have,  however,  deemed  it  quite  unneces- 
sary for  our  purpose  to  pass  these  cases  in  review.  How- 
ever numerous,  or  however  fantastic  or  various  in  character, 
they  all  serve  to  illustrate  only  one  fact,  namely,  that,  when 

1  Neuroses  Menstruelles. 


230  THE   QUESTION   OF   REST    FOR   WOMEN. 

the  nutrition  of  the  brain  centres  is  weakened,  increase  of 
blood  pressure  will  cause  various  degrees  of  irritation  of  the 
elements  of  which  their  tissues  are  composed.  These  patho- 
logical causes  are  of  no  value  for  our  purpose,  except  as 
indicating  the  rhythmic  increase  of  vascular  tension  upon 
which  we  have  insisted  ;  and  they  do  not  in  the  least  show 
that  menstruation,  per  sc,  constitutes  any  temporary  pre- 
disposition to  either  hysteria  or  insanity.  5.  The  real  pre- 
disposition to  all  the  grand  neuroses  lies,  not  in  the  peri- 
pheric  conditions  that  may  become  exciting  causes  of  their 
development,  but  in  the  original  structure  of  the  central  ner- 
vous organs,  without  which  these  peripheric  irritations  could 
have  no  effect.  From  what  we  have  said  of  the  peculiar 
mode  of  nutrition  that  obtains  in  the  female  economy,  it 
becomes  evident  why  women  are  so  very  much  more  fre- 
quently hysterical.  If  the  physiological  denutrition  of  the 
muscles  be  extended  to  the  nerve  centres,  we  have  the  atonic 
hysteria  of  towns ;  if  the  supplemental  wave  of  nutrition  be 
formed  at  the  expense  of  the  nerve  centres  instead  of  the 
muscles,  we  have  the  muscular  hysteria  of  peasants.  It  is 
indeed  primarily  owing  to  the  necessities  of  reproductive 
nutrition  that  women  are  more  liable  to  hysteria,  and  to 
anemia  than  men.  But  until  the  anatomical  basis  of  these 
diseases  shall  have  been  raised,  the  "  reproductive  demand  " 
can  only  be  considered  a  "  cause"  of  them,  in  the  same  sense 
in  which  birth  may  be  said  to  cause  death.  In  a  word,  when- 
ever women  exhibit  mental  irritability  and  consequent  weak- 
ness, at  or  before  menstruation,  it  is  a  proof  that  the  resist- 
ance of  their  nerve  centres  is  weakened  below  the  normal 
standard,  sometimes  congenitally  and  by  inheritance.  If  the 
impairment  be  sufficiently  extensive,  mental  action  will  be 
rendered  unreliable,  and  the  woman  be  subjected,  therefore, 
to  periods  of  temporary  incapacity,  of  varying  degrees.  In 
certain  such  cases,  the  attempt  to  force  mental  action  would 
interfere  still  further  with  the  nutrition  of  nerve  tissues,  and 


RESISTANCE   OF   NERVE   CENTRES   IN   WOMEN.         231 

hence  aggravate  the  original  difficulty.  In  these  cases  rest  is 
desirable  during  whatever  period  of  the  month  the  nervous  ex- 
citement may  be  experienced ;  but  this  will  be  more  frequently 
through  the  two  or  three  days  preceding  the  hemorrhage, 
than  at  the  time  of  the  flow.  In  slighter  cases,  rest  is  un- 
necessary ;  in  those  more  severe,  it  is  in  itself  useless,  i.  e., 
other  measures  must  be  taken  in  order  to  cure  the  disease. 
In  those  cases  of  congenital  hysteria  where  a  cure  cannot  be 
effected,  it  is  evident  that  the  women  are  permanently  unfit 
to  bear  severe  responsibilities,  or  to  undergo  mental  strain. 
Of  their  mental  action  it  must  be  said,  as  we  have  said  in 
regard  to  muscular  action  in  weak  subjects,  that  at  any  time 
it  tends  to  exhaust  the  small  reserve  of  force  accumulated 
by  the  feeble  nutritive  capacity  of  the  tissues.  Thus,  if 
beyond  the  individual  capacity  at  an  intermenstrual  period, 
it  will  inflict  an  injury  that  cannot  be  repaired  by  rest  during 
menstruation. 

In  regard  to  women  other  than  those  considered  in  the 
above  classes,  we  can  find  no  reason  to  suppose  that  men- 
strual rest  is  desirable  or  necessary.  Wherever  it  is  so,  it 
will  be  taken,  i.  e.,  no  really  mental  work  will  ever  be  per- 
formed at  a  time  that  the  brain  is  really  unable  to  perform  it. 
Whatever  is  done  at  such  times,  should  be  classed  with  work 
involving  muscular  effort  and  the  strain  of  fixed  attention. 
It  is,  therefore,  only  in  regard  to  school  girls  and  young  per- 
sons, called  upon  to  perform  mental  work  to  order,  (i.  e.  with- 
out spontaneity)  that  the  question  really  practically  applies. 
To  these  must  be  applied  all  that  has  been  said  in  the  fore- 
going paragraph,  with  one  addition,  that  in  adolescence, 
and  during  the  first  years  that  the  reproductive  wave  of  nu- 
trition is  being  formed,  mental  work  exacted  in  excess  of  the 
capacity  of  the  individual,  may  seriously  derange  the  nutri- 
tion. In  grading  the  work  therefore,  it  must  be  proportioned  ; 
1st.  To  the  conscious  ease  with  which  it  can  be  performed. 
2d.  To  the  duration  of  the  separate  sessions  of  study.  3d. 


232  CONCLUSION. 

To  the  known  standard  of  nutrition  of  the  nerve  centres,  in 
the  individual  case,  especially  as  measured  by  predisposition 
to  hysteria,  chorea,  insanity  or  consumption.  4th.  To  the 
coincident  maintenance  of  proper  hygienic  conditions,  es<» 
pecially  in  regard  to  food,  air  and  exercise.  The  regulations 
for  menstruation,  as  said,  to  be  entirely  individual,  and  in 
accordance  with  what  has  been  detailed  in  speaking  of  the 
mental  work  of  adult  women. 

Any  modifications  which  may  be  demanded  in  female  labor 
(modifications  unnecessary  in  multitudes  of  individual  cases, 
but  desirable  for  the  mass)  are  in  relation,  not  with  the  men- 
strual flow,  nor  with  "nervous  excitability"  which  may  be 
occasioned  by  it  in  pathological  cases,  but  with  the  nutritive 
provision  for  reproduction,  of  which  the  flow  is  only  one  in- 
dication. //  is  to  the  development  of  a  supplemental  ivave  of 
nutrition,  and  tlic  manner  in  wliicli  it  intersects  tJic  ivaves  of 
individual  nutrition,  that  are  due  most  of  the  peculiarities  of 
the  female  organism  and  of  its  activity,  and  not  the  mere 
existence  of  reproductive  organs.  For  theoretical  reasons 
exposed  in  detail,  and  from  the  results  of  observation,  we  are 
authorized  in  asserting  that  women  do  work  better,  and  with 
much  greater  safety  to  health  when  their  work  is  frequently 
intermitted  ;  but  that  those  intermittences  should  be  at  short 
intervals  and  lasting  a  short  time,  not  at  long  intervals  and 
lasting  longer. 

Finally,  that  they  are  required  at  all  times,  and  have  no 
special  reference  to  the  period  of  the  menstrual  flow. 

It  remains  true,  however,  that  in  our  existing  social  con- 
ditions, 46  per  cent,  of  women  suffer  more  or  less  at  menstru- 
ation, and  for  a  large  number  of  these  when  engaged  in 
industrial  pursuits  or  others,  under  the  command  of  an  em- 
ployer, humanity  dictates  that  rest  from  work  during  the 
period  of  pain  be  afforded  whenever  practicable. 


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and  understandable  manner,  and  the  illustrations  are  excellent." — Schmidt's  Jarbilclier  der  rje*ammten. 
Medicin,  1S76,  No.  1.  6/@(/Sy£- 

GARDNER.  Household  Medicine.  Containing  a  Familiar  Description  of 
Diseases,  their  Nature  and  Symptoms,  Methods  of  Treatment,  Uses  of  Re- 
medies, Rules  for  the  Management  of  the  Sick-Room,  etc.,  etc  ,  expressly 
adapted  for  Family  Use.  By  JOHN  GARDNER,  M.D.  Seventh  Edition. 

With  numerous  illustrations.  Svo 5  00 

GOLDING.     Synopsis  of  Percussion,   Auscultation   and   other    Methods  of 

Physicial  Diagnosis.     By  R.  C.  GOLDING,  M.D.     32mo,  cloth 50 

HART.  A  Manual  of  Public  Health.  For  the  use  of  Local  Authorities,  Medi- 
cal Officers  of  Health,  and  others.  By  W.  H.  MICHAEL,  F.C.S.;  W.  H. 
CORFIELD,  M.D.;  and  J.  A.  WANKLYN,  M.R.C.S.  Edited  by  ERNEST 
HART.  Svo,  cloth 500 


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